Surgical and Conservative Treatment Approaches in Cases of Central Cord Syndrome: A Systematic Review and Meta-Analysis

INTRODUCTION: Management of central cord syndrome (CCS) is still controversial. This study aimed to examine the roles and timing of conservative and surgical management in CCS. METHODS: A systematic review was conducted according to the PRISMA guidelines to identify articles describing the use of conservative and/or surgical methods in the management of CCS. Data extracted was subsequently meta-analyzed. RESULTS: A total of 37 articles detailing 99 cases of adult CCS were identified with 79 males and 20 females. Patients receiving surgery were all female patients (100% vs. 0%, p<0.05), and had higher rates of established spondylosis (43.2% vs. 11.8%, p<0.05). Conservative management was more frequent in cases of CCS from sports trauma (35.3% vs. 1.23%, p=0.0000) and in patients presenting with upper extremity motor deficits at presentation (94.1% vs. 50.6%, p<0.01), symptoms of pain (52.9% vs. 21%, p<0.05), and autofusion on diagnostic imaging (29.4% vs. 1.23%, p=0.0001). Predictors of surgical intervention included a time lapse of >24 hours after injury (p<0.001, OR: 17.18, 95% CI: 3.00-182.81) and spondylosis on diagnostic imaging (p<0.01, OR: 8.84, 95% CI: 1.82-86.09). Additionally, surgical intervention was found to be less likely with increased patient age (p<0.01, OR: 0.96, 95% CI: 0.93-0.98). Meanwhile, sports trauma was a predictor of conservative management (p<0.001, OR: 0.03, 95% CI: 0.00-0.29). There was no statistically significant difference in symptomatic improvements between the two management strategies (87.7% vs 100%, p=0.2765). CONCLUSION: Understanding these predictors and outcomes can aid in personalized treatment decisions for CCS cases. Early surgical intervention within 24 hours of injury does not appear to be superior to conservative management with possible deferred operation.