Neurological and functional recovery after early versus late surgical decompression in traumatic central cord syndrome, a post-hoc analysis from the SCI-POEM study

Study Design Post-hoc analysis Objectives To evaluate whether early surgical spinal decompression (≤ 12 hours) resulted in a greater neurological and functional recovery after 12 months compared to late decompression (> 12 hours and < 14 days) in motor incomplete tetraplegia, with or without traumatic central cord syndrome (TCCS). Setting European multicentre study Methods Data were obtained from SCI-POEM study. Early and late decompression groups. Motor-incomplete tetraplegia cases were further classified into three groups: (1) Non-TCCS upper extremity motor score (UEMS) equal or exceeding lower extremity motor score (LEMS) by ≥ 1 point), (2) Intermediate-TCCS (int-TCCS) (LEMS exceeding UEMS by 1–9 points), and (3) TCCS (LEMS exceeding UEMS by ≥ 10 points). The primary outcome was the change in UEMS, LEMS, and total motor scores (TMS) from baseline to 12 months. Secondary outcomes included changes in total Spinal Cord Independence Measurement (SCIM) scores. Independent-samples t-tests and ANCOVA were used for analysis. Results Out of 321 patients included in the SCI-POEM study, 59 subjects met eligibility criteria for this secondary analysis. Out of the 59 included patients, 16 (27%) were classified as TCCS, 23 (39%) int-TCCS, and 20 (34%) as non-TCCS. For TCCS patients, no significant differences were identified in improvement of UEMS 16.5 (95% CI 13.1; 19.8) and 16.9 (95% CI 14.2;19.5), LEMS 14.0 (95% CI 7.4; 20.6) and 13.0 (95% CI 8.6;17.5), SCIM 97.0 (95% CI 80.5;113.4) and 92.3 (95% CI 80.7; 104.0) between the early and late group from baseline to 12 months. In addition, no significant differences were identified in the intermediate-TCCS and non-TCCS between the early and late group. Conclusion Early surgical spinal decompression did not yield significant differences in neurological and functional outcomes between patients with motor incomplete tetraplegia (with or without TCCS) compared to late decompression.