Journal of Orthopedics and Joint Surgery

Register      Login

VOLUME 6 , ISSUE 1 ( January-June, 2024 ) > List of Articles


A Study of Functional and Radiological Outcome in Anterior Cervical Discectomy and Fusion with Stabilization in Posttraumatic Acute Central Cord Syndrome

Sivakumar Raju, Sudeep K Velur Nagendra, Vinoth Thangamani, Bharat K Ramalingam Jeyashankaran, D Abinav Annamalai

Keywords : Anterior cervical discectomy and fusion, American Spinal Injury Association score, Bridwell score, Central cord syndrome, Cervical spine injury, Modified Japanese Orthopedic Association score, Visual analog score

Citation Information : Raju S, Nagendra SK, Thangamani V, Jeyashankaran BK, Annamalai DA. A Study of Functional and Radiological Outcome in Anterior Cervical Discectomy and Fusion with Stabilization in Posttraumatic Acute Central Cord Syndrome. 2024; 6 (1):1-11.

DOI: 10.5005/jojs-10079-1135

License: CC BY-NC 4.0

Published Online: 12-01-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Background: Spinal injuries account for around 6% of overall trauma patients, of which cervical spine injuries contribute >50%. Central cord syndrome (CCS) is the most common subtype of incomplete spinal cord and accounts for around 15–25% of all cases. The aim of this study is to assess the functional and radiological outcomes of posttraumatic acute CCS treated with anterior cervical discectomy and fusion (ACDF) with stabilization. Materials and methods: It is a prospective study done between October 2020 and September 2022 in the Department of Orthopaedics, Preethi Hospital. Our study consists of 23 patients with posttraumatic CCS treated with ACDF with stabilization. Neurological and functional outcomes were assessed using the modified Japanese Orthopedic Association (mJOA) scale, visual analog score (VAS), and American Spinal Injury Association (ASIA) score at regular intervals of 3 and 6 months and 1 and 2 years, respectively. Results: Our study population comprised 19 males and four females with posttraumatic acute CCS. The average follow-up was 12–24 months. Out of 23 patients, 13 had single-level fusion, and 10 patients had double-level fusion surgery. In our study, preoperative (pre-op) mean VAS decreased from 7.6 ± 0.84 to 6.9 ± 1.6 postoperatively, and the mean mJOA score decreased from 8.2 ± 2.2 to 14.5 ± 2.0 postoperatively were statistically significant. On comparing pre-op and postoperative ASIA neurological grading, statistically significant improvement of ASIA grades. Radiological outcomes according to Bridwell's fusion criteria in computer tomography (CT) were also excellent. Conclusion: To conclude, we recommended surgical decompression with ACDF as the current mode of treatment with excellent functional and radiological outcomes with long-term results for posttraumatic CCS.

  1. Nowak DD, Lee JK, Gelb DE, et al. Central cord syndrome. J Am Acad Orthop Surg 2009;17(12):756–765. DOI: 10.5435/00124635-200912000-00004
  2. Avila MJ, Hurlbert RJ. Central cord syndrome redefined. Neurosurg Clin N Am 2021;32(3):353–363. DOI: 10.1016/
  3. Divi SN, Schroeder GD, Mangan JJ, et al. Management of acute traumatic central cord syndrome: a narrative review. Glob Spine J 2019;9(1 Suppl):89S–97S. DOI: 10.1177/2192568219830943
  4. Machino M, Ando K, Kobayashi K, et al. Postoperative changes in spinal cord signal intensity in patients with spinal cord injury without major bone injury: comparison between preoperative and postoperative magnetic resonance images. J Neurosurg Spine 2020;1–8. DOI: 10.3171/2020.6.SPINE20761
  5. Yukawa Y, Kato F, Yoshihara H, et al. MR T2 image classification in cervical compression myelopathy: predictor of surgical outcomes. Spine (Phila Pa 1976) 2007;32(15):1675–1678. DOI: 10.1097/BRS.0b013e318074d62e
  6. Dvorak MF, Fisher CG, Hoekema J, et al. Factors predicting motor recovery and functional outcome after traumatic central cord syndrome: a long-term follow-up. Spine 2005;30(20):2303–2311. DOI: 10.1097/01.brs.0000182304.35949.11
  7. Jia Y, Zuo X, Zhang Y, et al. Effectiveness of different surgical methods in the treatment of acute central cord syndrome without fractures and dislocations of the cervical spine. J Back Musculoskelet Rehabil 2022;36(1):71–77. DOI: 10.3233/BMR-210377
  8. Chen TY, Lee ST, Lui TN, et al. Efficacy of surgical treatment in traumatic central cord syndrome. Surg Neurol 1997;48(5):435–440. DOI: 10.1016/s0090-3019(97)00037-2
  9. Merriam WF, Taylor TK, Ruff SJ, et al. A reappraisal of acute traumatic central cord syndrome. J Bone Joint Surg Br 1986;68(5):708–713. DOI: 10.1302/0301-620X.68B5.3782229
  10. Bosch A, Stauffer ES, Nickel VL. Incomplete traumatic quadriplegia. A ten-year review. JAMA 1971;216(3):473–478. PMID: 5107929.
  11. Bose B, Northrup BE, Osterholm JL, et al. Reanalysis of central cervical cord injury management. Neurosurgery 1984;15(3):367–372. DOI: 10.1227/00006123-198409000-00012
  12. Brodkey JS, Miller CF, Harmody RM. The syndrome of acute central cervical spinal cord injury revisited. Surg Neurol 1980;14(4):251–257. PMID: 7434192.
  13. Fehlings MG, Vaccaro A, Wilson JR, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the surgical timing in Acute Spinal Cord Injury Study (STASCIS). PloS One 2012;7(2):e32037. DOI: 10.1371/journal.pone.0032037
  14. Guest J, Eleraky MA, Apostolides PJ, et al. Traumatic central cord syndrome: results of surgical management. J Neurosurg 2002;97(1 Suppl):25–32. DOI: 10.3171/spi.2002.97.1.0025
  15. Uribe J, Green BA, Vanni S, et al. Acute traumatic central cord syndrome–experience using surgical decompression with open-door expansile cervical laminoplasty. Surg Neurol 2005;63(6):505–510. DOI: 10.1016/j.surneu.2004.09.037
  16. Song J, Mizuno J, Nakagawa H, et al. Surgery for acute subaxial traumatic central cord syndrome without fracture or dislocation. J Clin Neurosci 2005;12(4):438–443. DOI: 10.1016/j.jocn.2004.04.008
  17. Stevenson CM, Dargan DP, Warnock J, et al. Traumatic central cord syndrome: neurological and functional outcome at 3 years. Spinal Cord 2016;54(11):1010–1015. DOI: 10.1038/sc.2016.34
  18. Kim SW, Limson MA, Kim SB, et al. Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J 2009;18(2):218–231. DOI: 10.1007/s00586-008-0854-z
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.