With the wide use of modified radiography such as computed tomography (CT) and magnetic resonance imaging (MRI), degenerative cervical spine disorders with evident radiographic abnormalities are becoming increasingly frequent in the elderly [1], [2]. Abnormal changes include spondylolisthesis, disc degeneration, vertebral body remodeling, and enlargement of intraspinal ligamentous tissue, [3] which would inevitably lead to varying degrees of spinal stenosis in the manifestation of chronic spinal cord compression.

There is still a poor understanding of the natural history of cervical spondylosis myelopathy and its related-spinal cord injury. In the early stage, there were only imaging findings of spinal cord compression for most patients without obvious myelopathic symptoms, which represents the chronic progress of non-traumatic spinal cord injury (SCI) [4]. Studies have confirmed a series of risk factors for the progression to myelopathy including new or increasing radicular symptoms, the presentation of hyperintensity in T2-WI MRI, and abnormal signals in neurophysiology [5]. In addition, acute SCI tends to occur in patients with preexisting cervical stenosis, [6], [7] especially in groups with a high cord-canal-area ratio but a small buffer space available for the cord measured on MRI, or dynamic cervical sagittal imbalance on X-ray [8]. Meanwhile, central spinal cord syndrome (CSS) is the most common type of posttraumatic incomplete SCI (about 70%) in the elderly with preexisting degenerative cervical spinal cord decompression [9].

Spinal surgeons are confronted with more cases whose imaging findings are in contradiction with their clinical manifestation. The applicable treatment plan in these situations is often confusing and this is particularly relevant to the symptomatic absence or only mild myelopathy symptoms. It is not uncommon for mild or asymptomatic patients with radiographic cervical spinal stenosis to receive surgical intervention recommendations to reduce the risk of neurological injury caused by minor trauma. However, the present literature has illustrated that this point is still controversial [10]. It is necessary to analyze the prognostic and risk factors related to surgical treatment in combination with the patient's baseline status and the degree of post-injury neurological function. Therefore, this study collected clinical and radiographic data from a series of patients with preexisting degenerative cervical spinal cord compression in a single center, all of them suffered from CSS after a low-energy, minor traumatic event. Our research is to find out the optimal timing of operative management and help identify patients at high risk of neurological deterioration, and finally to provide clinical reference for improving the treatment outcome of CSS.