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Early surgical intervention alleviates sensory symptoms following acute traumatic central cord syndrome

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Abstract

Purpose

To investigate the impact of early versus delayed surgery on sensory abnormalities in acute traumatic central cord syndrome (ATCCS).

Methods

Pressure pain threshold (PPT), temporal summation (TS), conditioned pain modulation (CPM) and pain assessments were performed in 72 ATCCS patients (early vs. delayed surgical treatment: 32 vs. 40) and 72 healthy subjects in this ambispective cohort study. These examinations, along with mechanical detection threshold (MDT) and disabilities of arm, shoulder and hand (DASH), were assessed at 2 years postoperatively.

Results

Preoperatively, more delayed surgical patients had neuropathic pain below level compared with early surgical patients (P < 0.05). Both early and delayed surgical patients showed reduced PPT in common painful areas and increased TS, while reduced CPM only existed in the latter (P < 0.05). Reduced PPT in all tested areas, along with abnormalities in TS and CPM, was observed in patients with durations over 3 months. Both incidences and intensities of pain and pain sensitivities in common painful areas were reduced in both treatment groups postoperatively, but only early surgical treatment improved the CPM and TS. Follow-up analysis demonstrated a higher MDT and lower PPT in hand, greater TS, greater DASH, lower pain intensities and higher incidence of dissatisfaction involving sensory symptoms in delayed surgical patients than in early surgical patients (P < 0.05).

Conclusions

Central hypersensitivity may be involved in the persistence of sensory symptoms in ATCCS, and this augmented central processing may commence in the early stage. Early surgical treatment may reverse dysfunction of endogenous pain modulation, thus reducing the risk of central sensitization and alleviating sensory symptoms.

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Funding

Financial support from the National Natural Science Foundation of China Science Foundation Project (82072488) is gratefully acknowledged.

Author information

Author notes

  1. Kaiwen Chen, Cong Nie, Huan Song contributed equally to this work and co-first authors.

    Jianyuan Jiang, Chaojun Zheng contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China

    Kaiwen Chen, Cong Nie, Feizhou Lyu, Jianyuan Jiang & Chaojun Zheng

  2. Department of Nursing, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Huan Song

  3. Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY, 10212, USA

    Yu Zhu

  4. Department of Orthopedics, The Fifth People’s Hospital, Fudan University, Shanghai, 200240, China

    Feizhou Lyu

Authors
  1. Kaiwen Chen
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  2. Cong Nie
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  3. Huan Song
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  4. Yu Zhu
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Corresponding authors

Correspondence to Jianyuan Jiang or Chaojun Zheng.

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None of the authors have potential conflicts of interest to be disclosed. The authors alone are responsible for the content and writing of this paper.

Ethical approval

This study protocol was approved by the Ethics Committee of Huashan Hospital (Fudan University, Shanghai, China), and informed consent was obtained from all participants.

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Chen, K., Nie, C., Song, H. et al. Early surgical intervention alleviates sensory symptoms following acute traumatic central cord syndrome. Eur Spine J 32, 608–616 (2023). https://doi.org/10.1007/s00586-022-07447-w

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  • DOI: https://doi.org/10.1007/s00586-022-07447-w

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