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Study design:A questionnaire survey. Objectives:To evaluate the need for the introduction of quantitative diagnostic criteria for the traumatic central cord syndrome (TCCS).Setting:An online questionnaire survey with participants from all over the world. Methods:An invitation to participate in an eight-item online survey questionnaire was sent to surgeon members of AOSpine International. Results:Out of 3340 invited professionals, 157 surgeons (5%) from 41 countries completed the survey. Whereas most of the respondents (75%) described greater impairment of the upper extremities than of the lower extremities in their own TCCS definitions, symptoms such as sensory deficit (39%) and bladder dysfunctions (24%) were reported less frequently. Initially, any difference in motor strength between the upper and lower extremities was considered most frequently (23%) as a ‘disproportionate’ difference in power. However, after presenting literature review findings, the majority of surgeons (61%) considered a proposed difference of at least 10 points of power (based on the Medical Research Council scale) in favor of the lower extremities as an acceptable cutoff criterion for a diagnosis of TCCS. Most of the participants (40%) felt that applying a single criterion to the diagnosis of TCCS is insufficient for research purposes. Conclusion:Various definitions of TCCS were used by physicians involved in the spinal trauma care. The authors consider a difference of at least 10 motor score points between upper and lower extremity power a clear diagnostic criterion. For clinical research purposes, this diagnostic criterion can be considered as a face valid addendum to the commonly applied TCCS definition as introduced by Schneider et al. [ABSTRACT FROM AUTHOR]

Study design:Systematic review. Background:The applied definition of traumatic central cord syndrome (TCCS) lacks specific quantified diagnostic criteria. Objective:To review currently applied TCCS diagnostic criteria and quantitative data regarding the ‘disproportionate weakness’ between the upper and lower extremities described in original studies reporting on TCCS subjects. Methods:A MEDLINE (1966 to 2008) literature search was conducted. The descriptors applied to define TCCS were extracted from all included articles. We included original studies that reported on the differences in motor score (based on the Medical Research Council scale) between the total upper extremity motor score (UEMS) and the total lower extremity motor score (LEMS), in a minimum of five TCCS patients at the time of hospital admission. The mean difference between the total UEMS and the total LEMS of the patients included in each study was calculated. Case reports were excluded. Results:None of the identified studies on TCCS patients reported inclusion and/or exclusion criteria using a quantified difference between the UEMS and LEMS. Out of 30 retrieved studies, we identified seven different clinical descriptors that have been applied as TCCS diagnostic criteria. Nine studies reporting on a total of 312 TCCS patients were eligible for analysis. The mean total UEMS was 10.5 motor points lower than the mean total LEMS. Conclusions:There is no consensus on the diagnostic criteria for TCCS. Nevertheless, this review revealed an average of 10 motor points between the UEMS and LEMS as a possible TCCS diagnostic criterion. However, further discussion by an expert panel will be required to establish definitive diagnostic criteria. [ABSTRACT FROM AUTHOR]

Presents a case illustrating the difficulties in the differential diagnosis between synovial chondromatosis and chondrosarcoma. Possibility of malignant transformation of benign lesions; Presence of binucleated chondrocytes and cytological atypia; Curative option for synovial chondrosarcoma.