National trends in the management of central cord syndrome: an analysis of 16,134 patients

doi:10.1016/j.spinee.2014.09.015

. 2015 Mar 1;15(3):435-42.

doi: 10.1016/j.spinee.2014.09.015. Epub 2014 Sep 28.

National trends in the management of central cord syndrome: an analysis of 16,134 patients

David W Brodell¹, Amit Jain², John C Elfar³, Addisu Mesfin⁴

Affiliations

¹ Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14625, USA.
² Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, 5th Floor, JH Outpatient Center (JHOC), Baltimore, MD 21287, USA.
³ Spinal Surgery Division, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, USA.
⁴ Spinal Surgery Division, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, USA; Cancer Center, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA. Electronic address: Addisu_Mesfin@URMC.Rochester.edu.

PMID: 25264321
PMCID: PMC4339306
DOI: 10.1016/j.spinee.2014.09.015

National trends in the management of central cord syndrome: an analysis of 16,134 patients

David W Brodell et al. Spine J. 2015.

. 2015 Mar 1;15(3):435-42.

doi: 10.1016/j.spinee.2014.09.015. Epub 2014 Sep 28.

Authors

David W Brodell¹, Amit Jain², John C Elfar³, Addisu Mesfin⁴

Affiliations

¹ Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14625, USA.
² Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, 5th Floor, JH Outpatient Center (JHOC), Baltimore, MD 21287, USA.
³ Spinal Surgery Division, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, USA.
⁴ Spinal Surgery Division, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, USA; Cancer Center, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA. Electronic address: Addisu_Mesfin@URMC.Rochester.edu.

PMID: 25264321
PMCID: PMC4339306
DOI: 10.1016/j.spinee.2014.09.015

Abstract

Background context: Central cord syndrome (CCS) is a common cause of incomplete spinal cord injury. However, to date, national trends in the management and mortality after CCS are not fully understood.

Purpose: To analyze how patient, surgical, and institutional factors influence surgical management and mortality after CCS.

Study design: A retrospective cohort analysis.

Patient sample: The Nationwide Inpatient Sample (NIS) was queried for records of patients with a diagnosis of CCS from 2003 to 2010.

Outcome measures: They included in hospital mortality and surgical management, including anterior cervical decompression and fusion (ACDF), posterior cervical decompression and fusion (PCDF), and posterior cervical decompression (PCD).

Methods: Using International Classification of Diseases, Ninth Revision, Clinical Modification codes, patient records with a diagnosis of CCS from 2003 to 2010 were selected from the NIS database and sorted by inpatient mortality and surgical management. Demographic information (age, gender, and race) and hospital characteristics were evaluated with χ(2)-tests for categorical variables and t tests for continuous variables. Multivariate logistic regression models controlled for confounding.

Results: In this sample of 16,134 patients, a total of 39.7% of patients (6,351) underwent surgery. ACDF was most common (19.4%), followed by PCDF (7.4%) and PCD (6.8%). From 2003 to 2010, surgical management increased by an average of 40% each year. The overall inpatient mortality rate was 2.6%. Increasing age and comorbidities were associated with higher rates of patient mortality and a decreasing surgical rate (p<.01). Hospitals greater than 249 beds (p<.01) and the south (p<.01) were associated with a higher surgical rate. Rural hospitals (p<.01) and people in the second income quartile (p<.01) were associated with higher inpatient mortality.

Conclusions: Elderly patients with medical comorbidities are associated with a lower surgical rate and a higher mortality rate. Surgical management was more prevalent in the south and large hospitals. Mortality was higher in rural hospitals. It is important for surgeons to understand how patient, surgical, and institutional factors influence surgical management and mortality.

Keywords: Central cord syndrome; Comorbidities; Demographics; Inpatient mortality; National database; Surgical management.

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Conflict of interest statement

Conflict of Interest:

David Brodell has no conflicts of interest.

Addisu Mesfin MD, Fellowship Funding from AO Spine.

Figures

**Figure 1**
Trends in surgical management of central cord syndrome 2003 to 2010.

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Comment in

Central cord syndrome: is operative treatment the standard of care?
Riew KD, Kang DG. Riew KD, et al. Spine J. 2015 Mar 1;15(3):443-5. doi: 10.1016/j.spinee.2014.12.017. Spine J. 2015. PMID: 25704242

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References

1. Harrop JS, Sharan A, Ratliff J. Central cord injury: pathophysiology, management, and outcomes. Spine J. 2006;6(6 Suppl):198S–206S. - PubMed
1. Ishida Y, Tominaga T. Predictors of neurologic recovery in acute central cervical cord injury with only upper extremity impairment. Spine. 2002;27:1652–7. - PubMed
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[1] Harrop JS, Sharan A, Ratliff J. Central cord injury: pathophysiology, management, and outcomes. Spine J. 2006;6(6 Suppl):198S–206S. - PubMed

[2] Harrop JS, Sharan A, Ratliff J. Central cord injury: pathophysiology, management, and outcomes. Spine J. 2006;6(6 Suppl):198S–206S. - PubMed

[3] Ishida Y, Tominaga T. Predictors of neurologic recovery in acute central cervical cord injury with only upper extremity impairment. Spine. 2002;27:1652–7. - PubMed

[4] Ishida Y, Tominaga T. Predictors of neurologic recovery in acute central cervical cord injury with only upper extremity impairment. Spine. 2002;27:1652–7. - PubMed

[5] Jimenez O, Marcillo A, Levi AD. A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome. Spinal Cord. 2000;38:532–537. - PubMed

[6] Jimenez O, Marcillo A, Levi AD. A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome. Spinal Cord. 2000;38:532–537. - PubMed

[7] Nowak DD, Lee JK, Gelb DE, et al. Central cord syndrome. J Am Acad Orthop Surg. 2009;17:756–765. - PubMed

[8] Nowak DD, Lee JK, Gelb DE, et al. Central cord syndrome. J Am Acad Orthop Surg. 2009;17:756–765. - PubMed

[9] Bosch A, Stauffer ES, Nickel VL. Incomplete traumatic quadriplegia: a ten-year review. JAMA. 1971;216:473–8. - PubMed

[10] Bosch A, Stauffer ES, Nickel VL. Incomplete traumatic quadriplegia: a ten-year review. JAMA. 1971;216:473–8. - PubMed

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National trends in the management of central cord syndrome: an analysis of 16,134 patients

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National trends in the management of central cord syndrome: an analysis of 16,134 patients

Authors

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Abstract

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