Trends in management of central cord syndrome: Insights from the New York State SPARCS database

Multiple surgical and non-surgical management options exist for treating central cord syndrome (CCS) patients. However, the final treatment decision is based on a patient's presentation and surgeon's choice. We aim to identify patient factors associated with decisions for surgical management versus non-surgical management of CCS and compare the outcomes of length of stay (LOS), patient disposition, readmission, complications, mortality, and total cost. This retrospective analysis of the New York Statewide Planning and Research Cooperative System (SPARCS) database identified CCS patients from January 1, 2012, to December 31, 2021. Surgical treatments were determined using International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes. Chi-square, T-test, and multivariable regression were used to compare outcomes, with random intercepts and effects for facilities. P < 0.05 was considered significant. Of 2214 patients, 41.24% (n = 891) underwent surgery. The majority (46.88%, n = 1038) were aged 40-65, followed by 46.48% (n = 1029) older than 65. Compared to non-surgically managed patients, surgically treated patients had a lower 90-day readmission rate, but a significantly longer length of stay, likelihood of non-home discharge, and total charge and cost. Of surgical modalities, posterior cervical decompression had the shortest mean LOS, probability of readmission, probability of readmission, and lowest mean total charge. Our study points toward surgery as having more favorable outcomes versus non-surgical management. The current study found that surgical management is associated with decreased probability of 90-day readmission and a non-significate decreased probability of mortality within 90 days of discharge.