Central cord syndrome is the most common form of an “incomplete spinal cord injury” characterized by damage to the central part of the spinal cord. It commonly occurs in elderly individuals with pre-existing spinal degeneration, often due to conditions like cervical spondylosis or disc herniation.
However, it can also occur in younger individuals following trauma, such as motor vehicle accidents or falls. This usually happens with a forward fall while striking the chin, and having the neck extend backward at the time of the fall.
The clinical presentation of central cord syndrome may vary from patient to patient. Some common symptoms include:
Bilateral motor weakness: Typically, the upper extremities are more affected than the lower extremities and the distal muscles are more affected than the proximal. Patients may experience difficulty with fine motor tasks, such as buttoning a shirt or holding objects.
Sensory changes: Patients may have decreased sensation or altered perception in their arms and hands. This can range from mild numbness to more profound sensory deficits.
Bladder and bowel dysfunction: In some cases, central cord syndrome can lead to urinary or fecal incontinence or difficulty with voiding.
Magnetic resonance imaging
MRI is essential to visualize the spinal cord and surrounding structures. MRI can provide valuable information about the location and severity of the spinal cord damage.
Management of central cord syndrome
The management of central cord syndrome involves a multidisciplinary approach aimed at maximizing functional recovery and improving the patient's quality of life. Here are some key management strategies:
Immobilization and stabilization: Patients with suspected spinal cord injuries should receive immediate spinal immobilization to prevent further damage. This can be achieved using cervical collars, backboards, or other appropriate immobilization devices.
Surgical intervention: In certain cases, surgical decompression may be necessary to relieve pressure on the spinal cord. This may involve removing herniated discs or stabilizing fractured vertebrae.
Rehabilitation: Once the acute phase has passed, a comprehensive rehabilitation program is crucial for optimizing functional outcomes. This may include physical therapy, occupational therapy, and assistive devices to promote mobility and independence.
The current consensus among experts is that the use of methylprednisolone in acute spinal cord injury remains controversial and its efficacy is uncertain.
Prognosis of central cord syndrome
The prognosis of central cord syndrome varies depending on the severity of the injury and the individual patient. Some patients experience significant recovery, while others may have residual deficits. Improvement occurs first in the legs, then the bladder, and may be seen in the arms. Hand function recovers last, if at all. The outlook is generally more favorable for younger individuals and those with milder forms of the condition.