Increasing Propensity for Surgical Management for Central Cord Syndrome Among Elderly Patients: A Nationwide Analysis from 2017 to 2021

Introduction: Central cord syndrome (CCS) represents the most common incomplete cervical spinal cord injury in the United States. Surgical decompression is the most common treatment for these patients. For elderly patients, there is increased hesitancy to operate given the high rate of comorbid health conditions that may complicate postoperative recovery. In recent years, there has been increasing literature suggesting that elderly patients may benefit from surgical treatment compared to conservative management. The purpose of this study is to evaluate the nationwide trends in operative treatment of CCS over a 5-year period within the past decade.

Methods: The National Trauma Data Bank was searched from 2017 to 2021 for all elderly (65+) patients with traumatic CCS. Surgical treatment was defined as surgical fixation and fusion or laminectomy decompression, while all others were defined as conservative management. The primary outcome variable was rate of surgical treatment. Pearson’s χ2 and analysis of variance tests were used to compare differences across years. Bejamini-Hochberg multiple comparisons correction was performed. A subgroup analysis was performed among octogenarians (80+).

Results: In total, 6128 patients met the inclusion/exclusion criteria. Annually, there were 1030, 1087, 1242, 1305, and 1464 patients each year from 2017 to 2021. The rate of surgical treatment from 2017 to 2021 was 57.28%, 57.04%, 60.87%, 65.36%, and 66.12% (p < 0.01), respectively. Among octogenarians, the rate of surgical treatment was 50%, 42.26%, 53.19%, 57.29%, and 58.15%, respectively. The rate of anterior fusion remained stable (mean 19.19%, p=0.93), however, posterior fusions increased significantly from 24.79% in 2017 to 38.98% in 2021 (p < 0.01).

Conclusion : Between 2017-2021, the rate of surgical treatment for elderly patients with CCS increased steadily from 57.28% to 65.36%, with a similar trend observed in octogenarians. In addition, a significant increase in posterior fusion was also observed. This suggests that spine surgeons are increasingly adopting a lower threshold to pursue surgical management for CCS in elderly patients. Further research is warranted to study the long-term effects of surgery and determine the optimal treatment in older patients.