Mechanism of injury and fracture status influence outcomes after central cord injury.

Central cord syndrome (CCS) is the most common form of incomplete cervical spinal cord injury (SCI), yet its optimal management remains controversial. We examined whether stratifying CCS by injury stability improves treatment assessment. CCS was defined as an American Spinal Injury Association Impairment Scale (AIS) C/D cervical SCI with a ≥5-point lower-upper extremity motor score difference and classified as CCS-stable (CCS-S) or -unstable (CCS-U) based on the absence or presence of fracture/dislocation. Functional recovery at 1 year was assessed using the functional independence measure (FIM) motor score. Among 291 patients, 131 (45%) had CCS-S. These patients were older and more frequently sustained fall-related injuries. In the propensity score-matched cohort, CCS-S showed greater functional improvement than CCS-U, although the difference was attenuated after multiplicity adjustment (mean difference 5.46 points, p = 0.24). Surgery was associated with higher odds of achieving the FIM motor minimum clinically important difference (MCID) in CCS-S (odds ratio [OR] = 2.85), supporting CCS-S as a distinct incomplete SCI phenotype with a more favorable postoperative recovery.