C-Spine

Central Cord Syndrome

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Central Cord Syndrome, Central Spinal Cord Syndrome

  • Epidemiology
  1. Most common Partial Cord Syndrome
  • Pathophysiology
  1. Hyperextension of the Cervical Spine (e.g. fall onto face)
  2. Edema and Hemorrhage into the central cord (gray matter and lateral Corticospinal tracts)
  3. Images
    1. CordSyndrome.jpg
  • Precautions
  1. Have a high index of suspicion in Trauma
  2. Findings may initially be subtle and mistakenly attributed to peripheral injury
  • Causes
  1. Older patients (most common)
    1. Cervical Spondylosis
    2. Cervical SpineOsteoarthritis
  2. Athletes
    1. Hyperextension with ligamentum flavum buckling
  3. Other mechanisms
    1. Unrestrained in Motor Vehicle Accident
  • Signs
  1. Bilateral motor weakness
    1. Upper extremities affected more than the lower extremities
    2. Distal extremities affected more than proximal extremities
  2. Sensory deficiency
    1. Variable
    2. Hyperesthesia may be present
  • Imaging
  1. MRI Spine without contrast (preferred)
  2. CT Spine
    1. Typically performed as initial study in Trauma
    2. May demonstrate Fracture or spinal subluxation
    3. However, CT is unlikely to identify cord compression
  • Management
  1. Consult Neurosurgery
  2. Decompression Surgery
    1. In acute Trauma-related cases, may result in better neurologic outcomes
    2. Anderson (2015) Neurosurgery 77(suupl 4):S15-32 [PubMed]
  • Prognosis
  1. Better than with other Partial Cord Syndromes
  • References
  1. Broder (2022) Crit Dec Emerg Med 36(3): 25
  2. Decker in Chorley and Bachur (2014) Overview of Cervical Spinal Cord Injuries..., UpToDate, Wolters-Kluwer
  3. Wagner (1997) Emerg Med Clin North Am 15:699-711 [PubMed]