THE SIGNIFICANCE OF DORSAL MIGRATION OF THE CORD AFTER EXTENSIVE CERVICAL LAMINECTOMY FOR PATIENTS WITH TRAUMATIC CENTRAL CORD SYNDROME

Central cord syndrome (CCS) resulting from traumatic cervical injury i s often associated with cervical stenosis and/or spondylosis. The effi cacy of multilevel laminectomy in the treatment of this condition has been controversial. The objective of this study was to validate by mag netic resonance (MR) imaging the occurrence of dorsal cord migration a fter extensive laminectomy for patients with the clinical syndrome of central cord damage and its relationship to the short-term outcome. Du ring a 28-month period, the authors evaluated 20 patients (mean age 54 years) who sustained CCS after cervical spine trauma. Pre- and post-o perative MR imaging assessed the adequacy of cervical cord decompressi on by multilevel laminectomy. All patients had cervical canal stenosis with complete obliteration of the anterior subarachnoid space over mu ltiple levels. Seventeen patients initially had CCS of different degre es of severity. One had no motor deficit and two had motor complete wi th sensory deficits greater in their arms. Laminectomy, generally from C2 to C7 without facetectomy, was performed after plateau of neurolog ical recovery (mean 17 days postinjury). Neurological assessment 3 mon ths 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 restor ation of anterior cerebrospinal fluid space and posterior cord migrati on in 12 patients (60% of the 20), but only 8 of them also had improve d function. MR imaging demonstrated that, in the presence of multileve l spondylosis/stenosis, laminectomy may provide adequate spinal cord d ecompression in patients with traumatic CCS. The lack of correlation b etween MR-documented decompression and ultimate level of recovery of f unction may be associated with the already established cord damage.