Central cord syndrome (CCS) resulting from traumatic cervical injury is often associated with cervical
stenosis and/or
spondylosis. The efficacy of multilevel
laminectomy in the treatment of this condition has been controversial. The objective of this study was to validate by magnetic resonance (MR) imaging the occurrence of dorsal cord migration after extensive
laminectomy for patients with the clinical syndrome of central cord damage and its relationship to the short-term outcome. During a 28-month period, the authors evaluated 20 patients (mean age 54 years) who sustained CCS after cervical spine
trauma. Pre- and postoperative MR imaging assessed the adequacy of cervical cord
decompression by multilevel
laminectomy. All patients had cervical canal
stenosis with complete obliteration of the anterior subarachnoid space over multiple levels. Seventeen patients initially had CCS of different degrees of severity. One had no motor deficit and two had motor complete with sensory deficits greater in their arms.
Laminectomy, generally from C2 to C7 without facetectomy, was performed after plateau of neurological recovery (mean 17 days postinjury). Neurological assessment 3 months after operation revealed improvement in 12, stable function in 7, and progression of deficit in one with no mortality. The postoperative midsagittal MR images demonstrated adequate
decompression with restoration of anterior cerebrospinal fluid space and posterior cord migration in 12 patients (60% of the 20), but only 8 of them also had improved function. MR imaging demonstrated that, in the presence of multilevel
spondylosis/
stenosis,
laminectomy may provide adequate spinal cord
decompression in patients with traumatic CCS.(ABSTRACT TRUNCATED AT 250 WORDS)