Below the Belt: Risk Factors for Urologic Adverse Events in Central Cord Syndrome

Introduction: Central cord syndrome (CCS) is an incomplete spinal cord injury associated with predominantly upper extremity sensory and motor dysfunction. Though there have been few investigations of urodynamic function in CCS patients, and no studies have characterized urologic complications as well as their predictors in CCS. The purpose of the present study was firstly to investigate predictors of any complication following admission for CCS, and then to specifically characterize predictors of urologic complications.

Methods: 41 CCS patients (12F) admitted from November 2020-April 2023 were retrospectively reviewed and had demographics, medical history and imaging data were collected. Medical history included ASIA score, history of HTN, CHF, arrhythmias, diabetes, medications, blood glucose at admission, mean arterial pressures (MAP), use of vasopressors, and complications. Imaging data included presence of cord edema, fracture, and ligamentous/disc injury. A binary logistic regression was utilized to quantify which variables were predictive of developing complications. Probability for stepwise entry and removal was 0.05 and 0.10, respectively. A second regression analysis was done on only patients with complications to predict which variables were predictive of urogenital complications in particular.

Results: ASIAC injury was predictive of developing any complication (χ2=8.47, OR=9.38 [2.08,42.34], p=0.004). Urogenital complications were present in 18/23 total patients with complications, including UTI, neurogenic bladder/bowel, and urinary retention. Predictors of urogenital complications were not taking statin medication (χ2=4.50, OR=0.024 [0.001,0.75], p=0.034) and high blood glucose (χ2=3.30, OR=1.03[0.99,1.05], p=0.070), though this was only significant in predicting complications and not significantly different between groups.

Conclusion : A more severe injury was predictive of developing complications in CCS patients. Urologic complications were particularly associated with high blood glucose levels, potentially due to an increased susceptibility to infection and neuropathy in that system. Statins may reduce risk of urogenital complication by its anti-inflammatory and protective effects in the endothelium, thereby improving blood flow in the urinary tract. Future studies are warranted to develop risk stratification tools in CCS patients with high risk factors for complications, especially urologic ones which may lead to downstream reduction in quality of life.