Central cord syndrome

Central cord syndrome (CCS) is the most commonform of cervical spinal cord injury. It is characterizedby loss of motor power and sensation in arms and hands.It usually results from trauma which causes damage to theneck, leading to major injury to the central grey matter.It is more common in patients over the age of 50 becauseosteoarthritis in the neck region, which causes weakeningof the vertebrae.The brain still has the capacity to send and receive signalsbelow the site of injury. It can send signals to and fromparts of the body but it is reduced not entirely blocked.This gives a greater motor loss in the upper limbs than inthe lower limbs, with variable sensory loss.CCS most frequently occurs among older persons withcervical spondylosis, however, it also may occur inyounger individuals.[1]

It was first described by Schneider in 1954.[2] CCS is themost common incomplete SCI syndrome. It accounts forapproximately 9% of traumatic SCIs.[3] It is generally as-sociated with favorable prognosis for some degree of neu-rological and functional recovery. However, factors suchas age, preexisting conditions and extent of injury willaffect the recovery process.

1 Presentation

It is characterized by disproportionately greater motorimpairment in upper compared to lower extremities, andvariable degree of sensory loss below the level of in-jury in combination with bladder dysfunction and urinaryretention.[4] This syndrome differs from that of a com-plete lesion, which is characterized by total loss of all sen-sation and movement below the level of the injury.

2 Causes

In older patients, CCS most often occurs after ahyperextension injury in an individual with long-standingcervical spondylosis. However, this condition is not ex-clusive to older patients as younger individuals can alsosustain an injury leading to CCS. Typically, younger pa-tients aremore likely to get CCS as a result of a high-forcetrauma or a bony instability in the cervical spine.[4][5]Historically, spinal cord damage was believed to origi-nate from concussion or contusion of the cord with sta-sis of axoplasmic flow, causing edematous injury rather

than destructive hematomyelia. More recently, autopsystudies have demonstrated that CCS may be caused bybleeding into the central part of the cord, portending lessfavorable prognosis. Studies also have shown from post-mortem evaluation that CCS probably is associated withselective axonal disruption in the lateral columns at thelevel of the injury to the spinal cord with relative preser-vation of the grey matter.[4]

3 Management

3.1 Nonsurgical

In many cases, individuals with CCS can experience a re-duction in their neurological symptoms with conservativemanagement. The first steps of these intervention strate-gies include admission to an intensive care unit (ICU) af-ter initial injury. After entering the ICU, early immo-bilization of the cervical spine with a neck collar wouldbe placed on the patient to limit the potential of furtherinjury.[5] Cervical spine restriction is maintained for ap-proximately six weeks until the individual experiences areduction in pain and neurological symptoms.[5] Inpatientrehabilitation is initiated in the hospital setting, followedby outpatient physical therapy and occupational therapyto assist with .An individual with a spinal cord injury may have manygoals for outpatient occupational and physiotherapy.Their level of independence, self-care, and mobility aredependent on their degree of neurological impairment.Rehabilitation organization and outcomes are also basedon these impairments.[6] The physiatrist, along with therehabilitation team, work with the patient to developspecific, measurable, action-oriented, realistic, and time-centered goals.With respect to physical therapy interventions, it has beendetermined that repetitive task-specific sensory input canimprove motor output in patients with central cord syn-drome. These activities enable the spinal cord to incorpo-rate both supraspinal and afferent sensory information tohelp recover motor output.[7] This occurrence is known as"activity dependent plasticity". Activity dependant plas-ticity is stimulated through such activities as: locomo-tor training, muscle strengthening, voluntary cycling, andfunctional electrical stimulation (FES) cycling[8]

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2 5 REFERENCES

3.2 Surgical

Surgical intervention is usually given to those individu-als who have increased instability of their cervical spine,which cannot be resolved by conservative managementalone. Further indications for surgery include a neuro-logical decline in spinal cord function in stable patientsas well as those who require cervical spinal decompres-sion.[9]

4 See also

• Rick Hansen Foundation

• NINDS Spinal Cord Injury Information Page

• Spinal cord injury

• Anterior cord syndrome

• Posterior cord syndrome

• Brown-Sequard syndrome

5 References

[1] Rich V, McCaslin E (2006). “Central Cord Syndrome ina High School Wrestler: A Case Report”. J Athl Train 41(3): 341–4. PMC 1569555. PMID 17043705.

[2] Schneider RC, Cherry G, Pantek H (1954). “Thesyndrome of acute central cervical spinal cord injury;with special reference to the mechanisms involved inhyperextension injuries of cervical spine”. J. Neurosurg.11 (6): 546–77. doi:10.3171/jns.1954.11.6.0546. PMID13222164.

[3] McKinley W, Santos K, Meade M, Brooke K (2007).“Incidence and Outcomes of Spinal Cord Injury ClinicalSyndromes”. J Spinal Cord Med 30 (3): 215–24. PMC2031952. PMID 17684887.

[4] Harrop, James S; Ashwini Sharan; Jonathon Ratliff(2006). “Central cord injury: pathophysiology, manage-ment, and outcomes”. The Spine Journal 6 (6 Suppl. 1):198S–206S. doi:10.1016/j.spinee.2006.04.006. PMID17097539.

[5] Nowak, Douglas D.; Joseph K. Lee; Daniel E. Gelb; Ko-rnelis A. Poelstra; Steven C. Ludwig (December 2009).“Central Cord Syndrome”. Journal of the AmericanAcademy of Orthopaedic Surgeons 17 (12): 756–765.PMID 19948700.

[6] Behrman, Andrea, L.; Harkema, Susan J. (2007). “Phys-ical Rehabilitation as an Agent for Recovery AfterSpinal Cord Injury”. Physical Medicine and Reha-bilitation Clinics of North America 18 (2): 183–202.doi:10.1016/j.pmr.2007.02.002. PMID 17543768.

[7] Behram, A.L.; Harkema, S.J. (2007). “Physical Re-habilitation as an Agent for Recovery After SpinalCord Injury”. Physical Medicine and Rehabilita-tion Clinics od North America 18 (2): 183–202.doi:10.1016/j.pmr.2007.02.002. PMID 17543768.

[8] Yadla, S.; Klimo, J.; Harrop, J.S. (2010). “TraumaticCentral Cord Syndrome: Etiology, Management, andOutcomes”. Topics in Spinal Cord Injury Rehabilitation15 (3): 73–84. doi:10.1016/j.spinee.2006.04.006. PMID17097539.

[9] Yadla, Sanjay; Paul Klimo; James S. Harrop (2010).“Traumatic Central Cord Syndrome: Etiology, Manage-ment, and Outcomes”. Topics in Spinal Cord Injury Reha-bilitation 15 (3): 73–84. doi:10.1310/sci1503-73.

Bibliography

• http://health.enotes.com/neurological-disorders-encyclopedia/central-cord-syndrome

• http://www.ninds.nih.gov/disorders/central_cord/central_cord.htm

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