Evaluating the Significance of Intervention Timing in Traumatic Central Cord Syndrome for Adult Populations: A Systematic Review and Meta-Analysis

Introduction: The optimal timing of intervention for cases of central cord syndrome (CCS) lacks consensus. Our study assesses whether early treatment (within 24 hours of onset) significantly impacts outcomes.

Methods: The literature regarding CCS intervention, timing, and outcomes, was systematically reviewed and meta-analyzed in accordance with PRISMA guidelines.

Results: 59 articles met inclusion criteria: 13 pooled, 8 comparative, and 38 case reports. Among the 86 patients in case reports, intervention occurred on average 3 [1,6] days post-diagnosis. Meta-analysis revealed no significant correlation between sex (OR: 1.00, 95% CI: 0.93-1.06, p=0.8983) or cause (fall (OR: 1.00, 95% CI: 0.94-1.05, p=0.8984), traffic accident (OR: 0.96, 95% CI: 0.88-1.05, p=0.3870), hyperflexion (OR: 1.02, 95% CI: 0.95-1.10, p=0.6032), other (OR: 0.66, 95% CI: 0.36-1.20, p=0.1762)) with intervention timing. However, spondylosis correlated with earlier intervention (OR: 1.22, 95% CI=1.05-1.42, p=0.0109). In 3 comparative studies, no significant association was found between presentation and early treatment. Surgery (OR: 5.59, 95% CI=1.52-20.59, p=0.0097) correlated with shorter diagnosis-to-intervention timing than conservative management (OR: 0.77, 95% CI=0.60-0.99, p=0.0404). Complications (wound infection: OR 0.77, 95% CI=0.39-1.50, p=0.4382; respiratory: OR 0.51, 95% CI=0.09-2.76, p=0.4309; cardiovascular: OR 0.77, 95% CI=0.30-1.97, p=0.5858) were not significantly associated with timing, and earlier treatment showed no significant association with neurological improvement (OR: 0.122, 95% CI=-0.583,0.827). Surgical management had higher prevalence (90.77%) than conservative (30.54%), with neurological improvement being the most prevalent outcome (77.50%), irrespective of timing.

Conclusion : Intervention timing insignificantly impacts CCS outcomes, highlighting the primacy of individual patient characteristics in clinical decision-making over stringent timelines. These findings prompt further research into the intricate interplay between patient-specific factors and optimal intervention strategies in CCS.