Central cord syndrome

Overview

Central cord syndrome (CCS) is a type of incomplete spinal cord injury characterized by damage to the central portion of the spinal cord. It typically results in greater weakness or paralysis in the upper limbs than in the lower limbs and may also involve sensory loss and bladder dysfunction. CCS is the most common form of incomplete spinal cord injury and often occurs in older adults with underlying cervical spine degeneration, especially after trauma or hyperextension injuries.

Causes

Central cord syndrome occurs when the central region of the spinal cord is damaged. Common causes include:

• Trauma: Especially hyperextension of the neck, often during falls or car accidents

• Cervical spondylosis: Age-related degeneration of the spine, leading to spinal canal narrowing (stenosis)

• Spinal cord compression: From herniated discs, bone spurs, or tumors

• Spinal cord ischemia: Reduced blood supply to the central portion of the spinal cord

• Congenital or acquired abnormalities: Such as syringomyelia or previous spinal surgeries

Symptoms

Symptoms of central cord syndrome can vary in severity depending on the extent of the injury. Typical signs include:

• Motor weakness: Greater weakness in the arms and hands than in the legs

• Loss of fine motor control: Especially in the hands and fingers

• Variable sensory loss: Including decreased sensation to pain, temperature, and touch

• Bladder dysfunction: Such as urinary retention or incontinence

• Possible bowel dysfunction

• Spasticity or increased muscle tone: In more chronic cases

Because CCS is an incomplete spinal cord injury, some motor and sensory function is usually preserved below the level of injury.

Diagnosis

Diagnosis of central cord syndrome involves a thorough clinical evaluation and imaging studies to assess the extent and location of spinal cord injury:

• Neurological examination: To evaluate motor strength, sensory loss, and reflexes

• Magnetic Resonance Imaging (MRI): The gold standard for detecting spinal cord compression, edema, or hemorrhage

• Computed Tomography (CT): Useful for evaluating bony abnormalities and fractures

• X-rays: May reveal degenerative changes or vertebral instability

• Urodynamic studies: If bladder dysfunction is present

Treatment

Treatment for central cord syndrome depends on the severity of symptoms and the underlying cause. Management typically includes:

• Initial stabilization: Especially after trauma, with immobilization of the spine and careful monitoring

• Medications: Such as corticosteroids (controversial), muscle relaxants, and pain relievers

• Physical and occupational therapy: Essential for improving motor function, especially in the arms and hands

• Bladder and bowel care: Including catheterization and training

• Surgical intervention: Indicated in cases of ongoing spinal cord compression, instability, or non-improvement with conservative management

• Assistive devices: Walkers or braces may be used during rehabilitation

Prognosis

The prognosis for central cord syndrome varies widely depending on the age of the patient, severity of the injury, and promptness of treatment. Many patients recover some function, particularly in the legs, but hand and arm function often remain impaired. Younger patients and those with less severe injury tend to have better outcomes. Long-term rehabilitation is often necessary, and some individuals may experience persistent weakness or disability. Early recognition and supportive care can significantly improve the quality of life and functional outcomes for individuals with CCS.