Diagnostic criteria of traumatic central cord syndrome. Part 2: A Questionnaire Survey among Spine Specialists

• Published in: Spinal cord Vol. 48; no. 9; pp. 657 - 663
• Main Authors: van Middendorp, J J, Pouw, M H, Hayes, K C, Williams, R, Chhabra, H S, Putz, C, Veth, R P H, Geurts, A C H, Aito, S, Kriz, J, McKinley, W, van Asbeck, F W A, Curt, A, Fehlings, M G, Van de Meent, H, Hosman, A J F
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2010; Nature Publishing Group
• Subjects: 631/378/1687/1825; 692/700/139; Anatomy; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Central Cord Syndrome - complications; Central Cord Syndrome - diagnosis; Central Cord Syndrome - physiopathology; Cerebrospinal fluid. Meninges. Spinal cord; Data Collection - standards; Diagnosis, Differential; Disability Evaluation; Human Physiology; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Medical sciences; Muscle Weakness - diagnosis; Muscle Weakness - etiology; Muscle Weakness - physiopathology; Nervous system (semeiology, syndromes); Neurochemistry; Neurology; Neuropsychology; Neurosciences; original-article; Paralysis - diagnosis; Paralysis - etiology; Paralysis - physiopathology; Surveys and Questionnaires - standards; Traumas. Diseases due to physical agents; spinal cord injury; central cord syndrome; survey; diagnostic criteria; Nervous system diseases; Questionnaire; Vertebral canal; Spine; Osteoarticular system; Survey; Spinal cord trauma; Central nervous system disease; Diagnosis; Spinal cord disease
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sc.2010.72

Study design: A questionnaire survey. Objectives: To evaluate the need for the introduction of quantitative diagnostic criteria for the traumatic central cord syndrome (TCCS). Setting: An online questionnaire survey with participants from all over the world. Methods: An invitation to participate in an eight-item online survey questionnaire was sent to surgeon members of AOSpine International. Results: Out of 3340 invited professionals, 157 surgeons (5%) from 41 countries completed the survey. Whereas most of the respondents (75%) described greater impairment of the upper extremities than of the lower extremities in their own TCCS definitions, symptoms such as sensory deficit (39%) and bladder dysfunctions (24%) were reported less frequently. Initially, any difference in motor strength between the upper and lower extremities was considered most frequently (23%) as a ‘disproportionate’ difference in power. However, after presenting literature review findings, the majority of surgeons (61%) considered a proposed difference of at least 10 points of power (based on the Medical Research Council scale) in favor of the lower extremities as an acceptable cutoff criterion for a diagnosis of TCCS. Most of the participants (40%) felt that applying a single criterion to the diagnosis of TCCS is insufficient for research purposes. Conclusion: Various definitions of TCCS were used by physicians involved in the spinal trauma care. The authors consider a difference of at least 10 motor score points between upper and lower extremity power a clear diagnostic criterion. For clinical research purposes, this diagnostic criterion can be considered as a face valid addendum to the commonly applied TCCS definition as introduced by Schneider et al.