eMedicine Specialties > Physical Medicine and Rehabilitation > Spinal Cord Injury

Central Cord Syndrome

Author: Michelle J Alpert, MD, Clinical Instructor, Department of Physical Medicine and Rehabilitation, Harvard Medical School
Contributor Information and Disclosures

Updated: Jul 29, 2009

Introduction

Background

Central cord syndrome (CCS), an acute cervical spinal cord injury (SCI), was initially described by Schneider and colleagues in 1954. It is marked by a disproportionately greater impairment of motor function in the upper extremities than in the lower ones, as well as by bladder dysfunction and a variable amount of sensory loss below the level of injury.1,2

Although CCS has been reported to occur more frequently among older persons with cervical spondylosis who sustain hyperextension injury, it can be found in persons of any age and can be associated with various etiologies, injury mechanisms, and predisposing factors.2 CCS is the most common incomplete SCI syndrome. (See image below and Image 1.)

Illustration of the pathophysiology of central co...

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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Illustration of the pathophysiology of central co...

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

Pathophysiology

Central cord syndrome (CCS) most often occurs after a hyperextension injury in an individual with long-standing cervical spondylosis. (See also the eMedicine article Cervical Spondylosis.) Injury may result from posterior pinching of the cord by a buckled ligamentum flavum or from anterior compression of the cord by osteophytes.3 Historically, spinal cord damage was believed to originate from concussion or contusion of the cord with stasis of axoplasmic flow, causing edematous injury rather than destructive hematomyelia. Autopsy studies subsequently demonstrated that CCS may be caused by bleeding into the central part of the cord, portending a less favorable prognosis. Studies have also shown that CCS probably is associated with axonal disruption in the lateral columns at the level of the injury to the spinal cord, with relative preservation of the grey matter.

The syndrome also may be associated with fracture dislocation and compression fracture, especially in a congenitally narrowed spinal canal.4 These anteroposterior compressive forces also distribute the greatest damaging effect on the central mass of the cord substance.

CCS-related motor impairment results from the pattern of lamination of the corticospinal and spinothalamic tracts in the spinal cord. Sacral segments are the most lateral, with lumbar, thoracic, and cervical components arranged somatotopically, proceeding medially toward the central canal.

Frequency

United States

The prevalence rate of central cord syndrome is 15.7-25%.

Mortality/Morbidity

Central cord syndrome is generally associated with a favorable prognosis for the achievement of some degree of neurologic and functional recovery.1,5,6

Sex

Similar to all other SCIs, central cord syndrome predominantly affects males.

Age

Central cord syndrome (CCS) has a bimodal distribution; in young persons, CCS tends to result from trauma, while in older individuals, it is typically caused by falls sustained by persons with preexisting spondylosis.5

Clinical

History

  • Symptoms of central cord syndrome occur following trauma (most commonly falls) and consist of upper and lower extremity weakness, with varying degrees of sensory loss.
  • Pain and temperature sensations, as well as the sensation of light touch and of position sense, may be impaired below the level of injury.
  • Neck pain and urinary retention are common.

Physical

Physical findings related to central cord syndrome are limited to the neurologic system and consist of upper motor neuron weakness in the upper and lower extremities. This impairment can be described as follows:

  • Impairment in the upper extremities is usually greater than in the lower extremities and is especially prevalent in the muscles of the hand.
  • Sensory loss is variable, although sacral sensation is usually present. Anal wink, anal sphincter tone, and Babinski reflexes should be tested.
  • Muscle stretch reflexes may initially be absent but will eventually return along with variable degrees of spasticity in affected muscles.

Causes

  • The most common cause of central cord syndrome (CCS) is trauma.
  • In older adults, premorbid cervical spondylosis is a significant risk factor.
  • Accordingly, even minor falls may result in tetraplegia in populations with a narrowed spinal canal.
  • In younger age groups, CCS results from major trauma, such as that associated with cervical fracture/subluxations.

More on Central Cord Syndrome

Overview: Central Cord Syndrome
Differential Diagnoses & Workup: Central Cord Syndrome
Treatment & Medication: Central Cord Syndrome
Follow-up: Central Cord Syndrome
Multimedia: Central Cord Syndrome
References
Further Reading
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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. Quencer RM, Bunge RP, Egnor M, et al. Acute traumatic central cord syndrome: MRI-pathological correlations. Neuroradiology. 1992;34(2):85-94. [Medline].

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

  5. 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].

  6. 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].

  7. 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].

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

  9. 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].

  10. 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].

  11. 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].

  12. 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].

  13. 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].

  14. 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].

  15. 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].

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

  17. 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].

  18. 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].

  19. 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].

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

  21. 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].

  22. 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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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.

Medical Editor

J Michael Wieting, DO, MEd, Professor of Physical Medicine and Rehabilitation, Professor of Osteopathic Principles and Practices, Director of Sports Medicine, Associate Director of Physician Assistant Training 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 Association of Neuromuscular and Electrodiagnostic Medicine, American College of Forensic Examiners, American College 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, 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, FAAPMR, FAAEM 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.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
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

 
 
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