Spondylotic traumatic central cord syndrome: a hidden discoligamentous injury?

• Published in: European spine journal Vol. 28; no. 2; pp. 434 - 441
• Main Authors: Krappinger, Dietmar, Lindtner, Richard A., Zegg, Michael J., Henninger, Benjamin, Kaser, Verena, Spicher, Anna, Schmid, Rene
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2019; Springer Nature B.V
• Subjects: Computed tomography; Decompression; Magnetic resonance imaging; Medicine; Medicine & Public Health; Neurosurgery; NMR; Nuclear magnetic resonance; Original Article; Spinal cord; Spinal cord injuries; Spine (cervical); Surgical Orthopedics; Trauma; Central cord syndrome; Magnetic resonance imaging; Hyperextension injury; Cervical spine injury; Discoligamentous injury
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-018-5796-5

Purpose To revisit the concept of spondylotic traumatic central cord syndrome (TCCS) by assessing the frequency of discoligamentous injury and to correlate magnetic resonance imaging (MRI) and intraoperative findings. Methods A retrospective analysis of twenty-three consecutive patients (mean age: 62.7 ± 14.8 years) with profound spondylotic TCCS after acute cervical hyperextension trauma but without signs of instability on initial CT scans who underwent anterior surgical decompression and fusion was performed. Sensitivity and specificity of MRI in the detection of anterior longitudinal ligament disruption were calculated. The topographic relations between surgically verified segmental instabilities and spinal cord signals on MRI were analyzed. The cervical MRI scans of all patients were evaluated by the radiologist on call at time of admission, re-assessed by a specialized MRI radiologist for the purpose of this study and compared with intraoperative findings. Results Intraoperative findings revealed 25 cervical spine segments with hyperextension instability in 22 of 23 (95.7%) patients. The radiologist on call correctly assessed segmental hyperextension instability in 15 of 25 segments (sensitivity: 0.60, specificity: 1.00), while the specialized MRI radiologist was correct in 22 segments (sensitivity: 0.88, specificity: 1.00). In 17 of 23 (73.9%) patients, the level of spinal cord signal on MRI matched the level of surgically verified segmental instability. Conclusions Our findings challenge the traditional concept of spondylotic TCCS as an incomplete cervical spinal cord injury without discoligamentous injury and emphasize the importance of MRI as well as the radiologist’s level of experience for the assessment of segmental instability in these patients. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.