Central Cord Syndrome Follow-up

  • Author: Michelle J Alpert, MD; Chief Editor: Denise I Campagnolo, MD, MS   more...
 
Updated: Apr 6, 2010
 

Further Inpatient Care

  • Admit to neurosurgical intensive care unit for neurologic monitoring.
  • Blood pressure monitoring is essential because mild hypertension is often recommended to ensure adequate blood flow to the spinal cord in the first 12-24 hours.
  • Perform prophylaxis for deep venous thrombosis (DVT), preferably with low molecular weight heparin.
  • Parenteral feeding is often necessary because of an adynamic ileus.
  • Insert a Foley catheter for bladder retention problems.
  • Initiate a regular bowel program.
  • Pay special attention to skin care (eg, regular turning schedule, specialized mattress).
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Further Outpatient Care

  • Carefully monitor neurologic recovery and the possible development of complications.
  • Spasticity, pressure ulcers, and neuropathic pain are commonly noted.
  • Provide whatever durable medical equipment (DME) the patient may need to facilitate safe ambulation or other mobility, as well as transfers, ADLs, or a return to vocational, avocational, educational, or social pursuits.
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Inpatient & Outpatient Medications

  • Lioresal is often indicated to treat spasticity that interferes with function.
  • Anticonvulsants (eg, carbamazepine, gabapentin) may be prescribed to treat recalcitrant neuropathic pain.[15]
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Complications

  • Pain/hyperpathia
  • Bladder retention
  • Spasticity
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Prognosis

  • The prognosis for patients with central cord syndrome (CCS) who are aged less than 50 years is good. Within a short time, 97% of these individuals recover, regaining the ability to ambulate and complete self-care tasks. Only 17% of patients aged more than 50 years recover.
  • Favorable long-term prognostic factors include good hand function, evidence of early motor recovery, documented increases in upper and lower extremity strength during initial rehabilitation, young age, and an absence of lower extremity neurologic impairment at admission to rehabilitation.[8, 16, 17]
  • In a retrospective review of 15 individuals with CCS, using plain radiographs, cervical CT scans, and MRI scans from each patient, Miranda et al concluded that the length of spinal cord edema in a patient correlates with his/her initial degree of neurologic impairment.[18] The authors determined, therefore, that for patients with CCS, length of spinal cord edema may provide a significant indication of prognosis.
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Patient Education

  • If necessary, patients and family members should be taught passive ROM and stretching exercises to maintain joint mobility. They should also be instructed in appropriate strengthening exercises.
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Contributor Information and Disclosures
Author

Michelle J Alpert, MD  Clinical Instructor, Department of Physical Medicine and Rehabilitation, Harvard Medical School

Michelle J Alpert, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Spinal Injury Association, and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Specialty Editor Board

J Michael Wieting, DO, MEd  Professor of Physical Medicine and Rehabilitation, Professor of Osteopathic Principles and Practices, Director of Program Development, Director of Sports Medicine, Associate Director of Physician Assistant Program, Department of Osteopathic Principles and Practice, Lincoln Memorial University-DeBusk College of Osteopathic Medicine

J Michael Wieting, DO, MEd is a member of the following medical societies: American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Osteopathic Academy of Sports Medicine, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, and International Society of Physical and Rehabilitation Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS  Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers

Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers

Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching; Genzyme Corporation Grant/research funds investigator; Biogen Idec Grant/research funds investigator; Genentech, Inc Grant/research funds investigator; Eli Lilly & Company Grant/research funds Novaritis; Novaritis Novaritis; MSDx LLC Grant/research funds investigator; BioMS Technology Corp Grant/research funds investigator; Avanir Pharmaceuticals Grant/research funds investigator

References

  1. Massaro F, Lanotte M, Faccani G. Acute traumatic central cord syndrome. Acta Neurol (Napoli). Apr 1993;15(2):97-105. [Medline].

  2. Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J Neurosurg. Nov 1954;11(6):546-77. [Medline].

  3. Nowak DD, Lee JK, Gelb DE, et al. Central cord syndrome. J Am Acad Orthop Surg. Dec 2009;17(12):756-65. [Medline].

  4. Lenehan B, Street J, O'Toole P, et al. Central cord syndrome in Ireland: the effect of age on clinical outcome. Eur Spine J. Oct 2009;18(10):1458-63. [Medline].

  5. Quencer RM, Bunge RP, Egnor M, et al. Acute traumatic central cord syndrome: MRI-pathological correlations. Neuroradiology. 1992;34(2):85-94. [Medline].

  6. Aarabi B, Koltz M, Ibrahimi D. Hyperextension cervical spine injuries and traumatic central cord syndrome. Neurosurg Focus. 2008;25(5):E9. [Medline].

  7. McKinley W, Santos K, Meade M, et al. Incidence and outcomes of spinal cord injury clinical syndromes. J Spinal Cord Med. 2007;30(3):215-24. [Medline]. [Full Text].

  8. Aito S, D'Andrea M, Werhagen L, et al. Neurological and functional outcome in traumatic central cord syndrome. Spinal Cord. Apr 2007;45(4):292-7. [Medline].

  9. Song J, Mizuno J, Inoue T, et al. Clinical evaluation of traumatic central cord syndrome: emphasis on clinical significance of prevertebral hyperintensity, cord compression, and intramedullary high-signal intensity on magnetic resonance imaging. Surg Neurol. Feb 2006;65(2):117-23. [Medline].

  10. Dai L. Magnetic resonance imaging of acute central cord syndrome: correlation with prognosis. Chin Med Sci J. Jun 2001;16(2):107-10. [Medline].

  11. Noonan VK, Kopec JA, Zhang H, et al. Impact of associated conditions resulting from spinal cord injury on health status and quality of life in people with traumatic central cord syndrome. Arch Phys Med Rehabil. Jun 2008;89(6):1074-82. [Medline].

  12. Gil-Agudo A, Perez-Rizo E, Del Ama-Espinosa A, et al. Comparative biomechanical gait analysis of patients with central cord syndrome walking with one crutch and two crutches. Clin Biomech (Bristol, Avon). Aug 2009;24(7):551-7. [Medline].

  13. Chen L, Yang H, Yang T, et al. Effectiveness of surgical treatment for traumatic central cord syndrome. J Neurosurg Spine. Jan 2009;10(1):3-8. [Medline].

  14. Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. May 17 1990;322(20):1405-11. [Medline].

  15. Haller H, Leblhuber F, Trenkler J, et al. Treatment of chronic neuropathic pain after traumatic central cervical cord lesion with gabapentin. J Neural Transm. Sep 2003;110(9):977-81. [Medline].

  16. Wirz M, Zorner B, Rupp R, et al. Outcome after incomplete spinal cord injury: central cord versus Brown-Sequard syndrome. Spinal Cord. Nov 10 2009;[Medline].

  17. Hohl JB, Lee JY, Horton JA, et al. A Novel Classification System for Traumatic Central Cord Syndrome: The Central Cord Injury Scale (CCIS). Spine (Phila Pa 1976). Mar 11 2010;[Medline].

  18. Miranda P, Gomez P, Alday R. Acute traumatic central cord syndrome: analysis of clinical and radiological correlations. J Neurosurg Sci. Dec 2008;52(4):107-12; discussion 112. [Medline].

  19. Chen TY, Lee ST, Lui TN, et al. Efficacy of surgical treatment in traumatic central cord syndrome. Surg Neurol. Nov 1997;48(5):435-40; discussion 441. [Medline].

  20. Maroon JC, Abla AA, Wilberger JI, et al. Central cord syndrome. Clin Neurosurg. 1991;37:612-21. [Medline].

  21. Nath M, Wheeler JS Jr, Walter JS. Urologic aspects of traumatic central cord syndrome. J Am Paraplegia Soc. Jul 1993;16(3):160-4. [Medline].

  22. Roth EJ, Lawler MH, Yarkony GM. Traumatic central cord syndrome: clinical features and functional outcomes. Arch Phys Med Rehabil. Jan 1990;71(1):18-23. [Medline].

  23. Siddall PJ, Taylor DA, McClelland JM, et al. Pain report and the relationship of pain to physical factors in the first 6 months following spinal cord injury. Pain. May 1999;81(1-2):187-97. [Medline].

  24. Tow AM, Kong KH. Central cord syndrome: functional outcome after rehabilitation. Spinal Cord. Mar 1998;36(3):156-60. [Medline].

  25. Waters RL, Adkins RH, Sie IH, et al. Motor recovery following spinal cord injury associated with cervical spondylosis: a collaborative study. Spinal Cord. Dec 1996;34(12):711-5. [Medline].

  26. Yamazaki T, Yanaka K, Fujita K, et al. Traumatic central cord syndrome: analysis of factors affecting the outcome. Surg Neurol. Feb 2005;63(2):95-9; discussion 99-100. [Medline].

 
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Illustration of the pathophysiology of central cord syndrome. Note the "pincer" effect on the central cord by anterior and posterior compression.
 
 
 
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