Study Examines Correlation between Demographic Factors and Management of Central Cord Syndrome

Central cord syndrome (CCS) is the most common type of incomplete spinal cord injury, and it usually occurs after hyperextension of the cervical spine. The condition often affects older patients due to degenerative changes with age that create a smaller space for the spinal cord. Patients frequently present with motor impairment that is more pronounced in the upper extremities than the lower extremities, bladder dysfunction, urinary retention, and sensory loss that has been described as “cape-like.”

Nonsurgical treatments include bracing or other immobilization, corticosteroids, physical therapy, and maintenance of mean arterial pressure. Surgical options include anterior cervical decompression and fusion (ACDF), posterior cervical decompression with or without fusion (PCD and PCDF), and cervical laminoplasty. However, optimal treatment and timing are not clear. Therefore, a recent study being presented at the AAOS 2025 Annual Meeting sought to explore outcomes when CCS is treated surgically versus nonsurgically.

The study assessed length of stay (LOS), discharge status, readmission within 90 days after discharge, complications within 90 days after discharge, mortality within 30 days of discharge, and costs. It also explored the association between outcomes and area deprivation index (ADI). ADI is an independently validated tool that evaluates a region’s socioeconomic conditions, which have been linked to health outcomes. The composite measurement includes 17 variables and is based on area code.

“Social disadvantage is an important factor to keep in mind when assessing outcomes, and there was a paucity of prior literature in CCS,” presenting author Clarke Cady-McCrea, MD, orthopaedic surgery resident at the University of Rochester School of Medicine and Dentistry, told AAOS Now Daily Edition. “It is imperative to recognize potential for disparities in care.”

The researchers reviewed the New York Statewide Planning and Research Cooperative System inpatient database and identified 2,214 patients diagnosed with CCS from Jan. 1, 2012, through Dec. 31, 2021. Of those patients, 93 percent were aged 65 years or older, 74 percent were male, and 60 percent were white. Most patients were admitted in an emergency department (72 percent), and fewer than half had private insurance (41 percent).

Of the total sample, fewer than half were treated with surgery (40 percent). PCD was the most common type of surgery (16 percent), followed by PCDF (9 percent) and ACDF (9 percent). Surgical patients had a significantly lower 90-day readmission rate than those treated nonsurgically. However, they also had a significantly longer LOS, were more likely to be discharged to somewhere other than home, and had higher costs of care. When the researchers compared surgical modalities, they found that PCD was associated with the shortest LOS, lowest probability of readmission, and lowest costs. PCDF was associated with the highest probability of readmission, and ACDF was most associated with complications and 30-day mortality.

Patients with lower socioeconomic status according to ADI were less likely to receive surgery. “This aligns with previous studies where patients from lower socioeconomic backgrounds tend to have less access for orthopaedic care,” the authors wrote. Those with higher socioeconomic status had shorter LOS, lower readmission rates, fewer complications, lower risk of mortality, and lower costs of care.

“Our study found that fewer disadvantaged patients undergo surgical intervention, which is associated with improved outcomes, representing an area of potential bias,” Dr. Cady-McCrea said. “It is beyond the scope of this paper to comment on causality. Regardless, in an ideal world, we would hope to find equal rates of surgical intervention across all socioeconomic classes.” He added that the findings reinforce the importance of remaining vigilant against bias, especially subconscious bias, when discussing and offering treatment options.

Paper 029 will be presented during VIPER: Spine I Papers, 8 a.m. on Monday in Room 9.

Dr. Cady-McCrea’s coauthors of “Trends in Management of Central Cord Syndrome: The Role of Area Deprivation Index” are Kevin Yoon, BS; Gabriel Anthony Ramirez, MS; and Addisu Mesfin, MD.

Keightley Amen, BA, ELS, is a freelance writer for AAOS Now.