Diagnostic criteria of traumatic central cord syndrome. Part 2: A Questionnaire Survey among Spine Specialists
Abstract
Study design: A questionnaire survey. Objectives: To evaluate the need for the introduction of quantitative diagnostic criteria for the traumatic central cord syndrome (TCCS).
Setting: An online questionnaire survey with participants from all over the world. Methods: An invitation to participate in an eight-item online survey questionnaire was sent to surgeon members of AOSpine International.
Results: Out of 3340 invited professionals, 157 surgeons (5%) from 41 countries completed the survey. Whereas most of the respondents (75%) described greater impairment of the upper extremities than of the lower extremities in their own TCCS definitions, symptoms such as sensory deficit (39%) and bladder dysfunctions (24%) were reported less frequently.
Initially, any difference in motor strength between the upper and lower extremities was considered most frequently (23%) as a 'disproportionate' difference in power. However, after presenting literature review findings, the majority of surgeons (61%) considered a proposed difference of at least 10 points of power (based on the Medical Research Council scale) in favor of the lower extremities as an acceptable cutoff criterion for a diagnosis of TCCS.
Most of the participants (40%) felt that applying a single criterion to the diagnosis of TCCS is insufficient for research purposes. Conclusion: Various definitions of TCCS were used by physicians involved in the spinal trauma care.
The authors consider a difference of at least 10 motor score points between upper and lower extremity power a clear diagnostic criterion. For clinical research purposes, this diagnostic criterion can be considered as a face valid addendum to the commonly applied TCCS definition as introduced by Schneider et al.
Spinal Cord (2010) 48, 657-663; doi:10.1038/sc.2010.72; published online 29 June 2010