Surgical Timing and Neurological Outcomes in Traumatic Central Cord Syndrome: A Single-Center Retrospective Cohort Study

Study Design: Retrospective Cohort. Objective: To investigate whether the timing of surgery, defined by admission-to-surgery intervals, influences short-term in-hospital outcomes and motor recovery in adult patients with Central Cord Syndrome (CCS). This single-center study aimed to investigate the optimal timing for surgery in patients with CCS by using a new categorization of surgical timing. Methods: This study includes adult patients with clinically and radiologically confirmed traumatic CCS who received surgical care at a tertiary academic center between March 2012 and July 2022 (n = 70). Patients were classified by time of surgery as ultra-early (<24 h, n = 11), early (24-48 h, n = 33), late (48 h-14 days, n = 22), or ultra-late (>14 days, n = 4). The studied outcomes were in-hospital mortality, mechanical ventilation requirement, ventilation duration, intensive care unit (ICU) length of stay, ambulatory status at last follow-up, and changes in motor score in each group. Chi-square and Kruskal-Wallis tests were used to compare groups. The correlation between surgical timing and motor improvement was identified using correlation analysis. Results: The four timing subgroups showed no significant differences in in-hospital mortality, ambulatory status, need for mechanical ventilation, ventilation duration, or ICU length of stay (p = 0.7, 0.4, 0.6, 0.8, and 0.3, respectively). Moreover, although there was a notable postoperative improvement in the total (four limbs), bilateral upper extremity (BUE), and bilateral lower extremity (BLE) motor scores, these improvements were not significantly different across subgroups (p = 0.7, 0.7, and 0.6, respectively). There was no significant correlation between surgery time and motor improvement (p = 0.63). Conclusions: In this single-center study, the timing of surgery after admission did not appear to influence short-term in-hospital outcomes or early motor recovery in adult patients with CCS. Key limitations of this study include the retrospective design, the small sample sizes in some surgical timing subgroups, and the reliance on admission-to-surgery timing rather than injury-to-surgery intervals. Furthermore, long-term follow-up data were not consistently available.