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Age <50 years is associated with improved ambulation and motor recovery
48%
525/1083
Presenting with ASIA D spinal cord injury is associated with a worse neurologic outcome
3%
31/1083
The presence of increased T2 spinal cord signal changes is associated with a rapid early decline in motor function
17%
187/1083
Administration of high-dose IV steroids results in improved neurologic outcomes
35/1083
Routine initial nonoperative treatment is recommended
27%
295/1083
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Patients <50 years of age with central cord syndrome have been associated with improved neurologic recovery. Central cord syndrome typically occurs with a hyperextension mechanism of the cervical spine in the setting of cervical spondylosis. It presents with motor weakness affecting the upper extremities more than the lower extremities. The prognosis for independent ambulation is generally good with >80% able to ambulate, but higher rates are seen in patients <50 years of age. Lenehan et al. performed a prospective study of 50 patients treated with traumatic central cord syndrome. They reported about 1/3 of patients were intoxicated at the time of injury with the greatest improvement in function was seen in patients <50 years of age. They concluded that clinical outcome was worse in patients in >70 years of age. Dvorak et al. performed a prospective study of patients treated for central cord syndrome. They reported 81% of attained bowel and bladder continence and 86% attained independent ambulation at final follow-up. They concluded initial ASIA score, presence of formal education, presence of comorbidities, age of injury, and presence of spasticity were predictive factors for motor recovery. Schroeder et al. performed a study of patients presenting with central cord syndrome and evaluated the effect of T2 spinal cord signal changes on neurologic outcomes. They reported an increase in T2 spinal cord signal changes was associated with a less severe decrease in the ASIA motor scale during the 1st week of the injury. They concluded a lack of T2 spinal cord signal changes was associated with a lower neurologic injury at presentation but a greater deterioration of ASIA motor scale during the 1st week. Pollard et al. performed a retrospective study of 412 patients presenting with incomplete spinal cord injury. They reported no significant improvement in neurologic recovery in patients treated with high-dose IV steroids, early surgical intervention, or routine decompression. Figure A is a sagittal T2 MRI of the cervical spine demonstrating diffuse cervical spondylosis and central canal stenosis and C5-6 spinal cord signal change consistent with central cord syndrome. Incorrect answers Answer 2: Patients presenting with mild spinal cord injuries (ASIA C and D) are associated with improved neurologic recovery. Answer 3: The presence of T2 spinal cord signal changes is associated with a less severe neurologic decline in the 1st week following injury. Answer 4: High-dose IV steroids have not been associated with improved neurologic recovery in patients with incomplete spinal cord injuries. Answer 5: Routine nonoperative treatment is not recommended in all cases. Some patients with higher-grade spinal cord injury (ASIA C) may benefit from early (<24 hours) surgical decompression.
2.9
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