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

Abstract

We read with great interest the article by Crasta et al 1 evaluating the relationship between surgical timing and neurological outcomes in acute traumatic central cord syndrome (ATCCS). The authors should be commended for an elegant study and for contributing to a pertinent research question regarding the timing of surgery in ATCCS, 2 which still fosters debate. Whilst these findings are a crucial addition to the body of knowledge, we must enquire more about the outcome measure that was utilized and comment on the heterogeneity of outcomes measures amongst ATCCS studies. The authors used an outcome measure which was a summation of 5 muscle groups in each extremity, which was then divided by 5, resulting in score of 0-5 for each limb. This novel motor outcome is analogous to the upper extremity and lower extremity motor scores, which are part of the American Spinal Injury Association (ASIA) Motor Score (AMS). The AMS is used widely in spinal cord injury and ATCCS studies as the motor outcome measure of choice. 3 With a larger range of values to describe the extent of motor impairment, from 0-25 for each motor extremity, AMS provides a finer scale for measuring the disease severity, with granularity better allowing for precision in reliably detecting clinical change. 4 There is a role for standardisation for outcome measures across various studies, allowing for common comparison across different populations and aiding future meta-analyses. Any proposed new outcome measure should be compared to AMS, to demonstrate its superiority. Another