title: The effect of increased T2 signal intensity in the spinal cord on the injury severity and early neurological recovery in patients with central cord syndrome.
abstract: OBJECTIVE The aim of this paper was to compare the severity of the initial neurological injury as well as the early changes in the American Spinal Injury Association (ASIA) motor score (AMS) between central cord syndrome (CCS) patients with and without an increased T2 signal intensity in their spinal cord. METHODS Patients with CCS were identified and stratified based on the presence of increased T2 signal intensity in their spinal cord. The severity of the initial neurological injury and the progression of the neurological injury over the 1st week were measured according to the patient's AMS. The effect of age, sex, congenital stenosis, surgery within 24 hours, and surgery in the initial hospitalization on the change in AMS was determined using an analysis of variance. RESULTS Patients with increased signal intensity had a more severe initial neurological injury (AMS 57.6 vs 75.3, respectively, p = 0.01). However, the change in AMS over the 1st week was less severe in patients with an increase in T2 signal intensity (-0.85 vs -4.3, p = 0.07). Analysis of variance did not find that age, sex, Injury Severity Score, congenital stenosis, surgery within 24 hours, or surgery during the initial hospitalization affected the change in AMS. CONCLUSIONS The neurological injury is different between patients with and without an increased T2 signal intensity. Patients with an increased T2 signal intensity are likely to have a more severe initial neurological deficit but will have relatively minimal early neurological deterioration. Comparatively, patients without an increase in the T2 signal intensity will likely have a less severe initial injury but can expect to have a slight decline in neurological function in the 1st week.
authors.affiliation: The Rothman Institute at Thomas Jefferson University; and 
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Schroeder
authors.affiliation: Departments of 2 Orthopaedic Surgery and.
authors.forename: Nik
authors.initials: N
authors.lastname: Hjelm
authors.affiliation: The Rothman Institute at Thomas Jefferson University; and 
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.affiliation: Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Weinstein
authors.affiliation: The Rothman Institute at Thomas Jefferson University; and 
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
mesh_terms: D000328:Adult; D000368:Aged; D020210:Central Cord Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: AMS = ASIA motor score; ASIA = American Spinal Injury Association; CCS = central cord syndrome; ISS = Injury Severity Score; SCI = spinal cord injury; T2 signal intensity; central cord syndrome; early neurological recovery; spinal cord injury