Abstract:

BACKGROUND: In the treatment of central cord syndrome, it is difficult to predict the degree of nerve recovery because of the different speeds and degrees of nerve recovery. The treatment of central cord syndrome, especially the treatment methods, is still controversial.

OBJECTIVE: To investigate the factors influencing the prognosis of central cord syndrome treated with drug therapy and titanium plate fixation.

METHODS: A retrospective analysis of 243 patients with central cord syndrome who were admitted to Changzhou Second People’s Hospital Affiliated to Nanjing Medical University from June 2012 to June 2017 was performed. According to therapeutic schedule, the patients were divided into two groups. In the titanium plate group, 152 cases were treated with titanium plate fixation, and 91 cases in the drug treatment group were treated with drugs. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Neurological function was assessed using American Spinal Injury Association and Japanese Orthopedic Association criteria. American Spinal Injury Association and Japanese Orthopedic Association scores were recorded for all patients within 24 hours of treatment, 6, 12, and 24 months after treatment. The age, treatment, and gender factors were included in the prognostic single factor analysis at 6 and 24 months after treatment of cervical spinal cord syndrome. After that, age, treatment and gender factors were included in the multivariate logistic regression analysis of prognosis at 6 and 24 months after treatment of cervical spinal cord syndrome.

RESULTS AND CONCLUSION: (1) 243 patients were followed up for at least 24 months and recovered well after treatment. (2) American Spinal Injury Association and Japanese Orthopedic Association scores were lower in the drug treatment group than in the titanium plate group at 6 months after treatment (P=0.001 2, 0.000 0). However, American Spinal Injury Association and Japanese Orthopedic Association scores were higher in the drug treatment group than in the titanium plate group at 24 months after treatment (P=0.037 4, 0.047 8). (3) The prognosis of central cord syndrome after 6 months of treatment was related to the age and treatment of the patients (P=0.007 2, P < 0.000 1). Moreover, drug treatment and age greater than 50 years were associated with poor prognosis in patients with central cord syndrome at 6 months after treatment (P=0.043, P=0.010). (4) The prognosis at the 24-month follow-up of central cord syndrome was correlated with the patient’s treatment (P=0.004 3). Moreover, the drug treatment was associated with prognosis at the 24-month follow-up of central cord syndrome (P=0.021). (5) Results indicated that at the time of titanium plate fixation, the recovery rate was faster in 6 months than that of drug treatment. However, at 24 months follow-up after treatment, the recovery effect of drug treatment was better than that of titanium plate fixation. At 6 months after treatment, the prognosis was related to the treatment mode and age, but at 24 months after treatment, the prognosis was related to the treatment mode.

Key words: titanium plate, internal fixation, drug therapy, central cord syndrome, prognosis, age, logistic regression analysis