Traumatic central cord Syndrome: An integrated neurosurgical and neurocritical care perspective.

IF 1.9 Q3 CLINICAL NEUROLOGY
Brain & spine Pub Date : 2025-05-17 eCollection Date: 2025-01-01 DOI:10.1016/j.bas.2025.104281
Karol Martínez-Palacios, Andrés M Rubiano, Andreas K Demetriades, Sebastián Vásquez-García
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Abstract

Traumatic Central Cord Syndrome (TCCS) presents complex challenges in the management of spinal cord injury. Characterized by disproportionate upper limb weakness, TCCS is the most common clinical spinal cord syndrome, typically affecting males in a bimodal age distribution. Mechanisms include hyperextension injuries in older adults with degenerative cervical spine disease and high-energy trauma in younger individuals. Diagnosis is based on neurological assessment, with the American Spinal Injury Association (ASIA) Impairment Scale used for severity classification. Management strategies, including surgical and medical approaches, may influence functional outcomes, although high-quality comparative evidence is limited. Surgical decompression and stabilization are often pursued to relieve mechanical compression, while nonoperative strategies may be considered in selected cases with less severe neurological deficits. The timing of surgical intervention remains a subject of ongoing debate and must be individualized. Neurocritical care considerations are increasingly recognized as potentially important in the early phase of TCCS. Experimental and clinical investigations into intraspinal pressure (ISP), mean arterial pressure (MAP), and spinal perfusion pressure (SPP) monitoring suggest these parameters may aid in minimizing secondary injury, though their routine clinical use is not yet established. Complications such as venous thromboembolism, infection, pressure injuries, and autonomic dysfunction are common and require comprehensive management. The role of corticosteroids remains controversial. This narrative review synthesizes current knowledge on TCCS, with emphasis on diagnostic, surgical, and neurocritical care considerations. As the field advances, further evidence is needed to clarify optimal management pathways and improve outcomes in this challenging clinical entity.

创伤性中枢脊髓综合征:综合神经外科和神经危重症护理的观点。
创伤性中枢性脊髓综合征(TCCS)在脊髓损伤的治疗中提出了复杂的挑战。TCCS以不成比例的上肢无力为特征,是最常见的临床脊髓综合征,通常影响双峰年龄分布的男性。机制包括退行性颈椎疾病老年人的过伸损伤和年轻人的高能创伤。诊断基于神经学评估,使用美国脊髓损伤协会(ASIA)损伤量表进行严重程度分类。尽管高质量的比较证据有限,但包括手术和医疗方法在内的管理策略可能会影响功能结果。手术减压和稳定通常是为了减轻机械压迫,而在一些神经功能不太严重的病例中,可以考虑非手术策略。手术干预的时机仍然是一个持续争论的主题,必须个体化。在TCCS的早期阶段,神经危重症的护理考虑越来越被认为是潜在的重要因素。椎管内压(ISP)、平均动脉压(MAP)和脊髓灌注压(SPP)监测的实验和临床研究表明,这些参数可能有助于减少继发性损伤,尽管它们的常规临床应用尚未建立。并发症如静脉血栓栓塞、感染、压力损伤和自主神经功能障碍是常见的,需要综合管理。皮质类固醇的作用仍有争议。这篇叙述性综述综合了目前关于TCCS的知识,重点是诊断、手术和神经危重症护理方面的考虑。随着该领域的发展,需要进一步的证据来阐明最佳管理途径并改善这一具有挑战性的临床实体的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Brain & spine
Brain & spine Surgery
CiteScore
1.10
自引率
0.00%
发文量
0
审稿时长
71 days
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