400 Age-Dependent Effectiveness of Surgical Intervention on Physical Function After Traumatic Central Cord Syndrome: A Propensity-Matched Analysis

INTRODUCTION: Traumatic Central Cord Syndrome (tCCS) often causes lasting functional impairment. Despite the increasing incidence of tCCS among older patients, the effectiveness of surgical intervention across the spectrum of age remains unclear. METHODS: We used data from 840 tCCS patients in the National Spinal Cord Injury Model Systems Database (a prospective, multicenter dataset) between 2005 and 2020. The primary outcome was the Physical Function Composite Score (PFCS, range 0-200) at 1-year follow-up, a linear combination of validated mobility and physical independence measures. Variable-ratio propensity score matching with calipers (0.2SD) ensured treatment group comparability. Multivariable linear regression modeled the association between surgery and physical function in the matched cohort. The effect modification of patient age on the association between surgery and physical function was further evaluated using rolling regression and segmented regression techniques. RESULTS: Propensity matching yielded 755 well-balanced tCCS patients (median age 57, IQR 47-66) undergoing surgery (n=584) or non-operative treatment. Younger patients experienced better 1-year PFCS (-0.69%/year, 95% CI [-0.47%, -0.92%]; P<0.001); however, there was a significant positive age-by-surgery interaction, indicating that surgery exerts greater benefit as age increases (0.49%/year, 95% CI [0.25%, 0.74%]; P<0.001). Segmented regression identified a breakpoint at age 68.0 years (95% CI [66.3,69.7]; P<0.001). For patients aged =68, surgery was associated with a 13.1% improvement in 1-year PFCS (95% CI [3.2%, 22.9%], P=0.001). In patients younger than 68, surgery did not significantly impact 1-year PFCS (P=0.3). The adjusted odds of receiving surgery did not vary with age (P=0.7). CONCLUSIONS: While younger tCCS patients expectedly have better long-term functional outcomes, surgical decompression may have differentially greater effectiveness in older tCCS patients. Decompression in older patients may address both acute injury and chronic, subclinical myelopathy. Future efforts should validate this observation and investigate underlying mechanisms.