Further Outpatient Care

See the list below:

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.

Further Inpatient Care

See the list below:

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).

Inpatient & Outpatient Medications

See the list below:

Lioresal is often indicated to treat spasticity that interferes with function.
Anticonvulsants (eg, carbamazepine, gabapentin) may be prescribed to treat recalcitrant neuropathic pain.^[41]

Complications

See the list below:

Pain/hyperpathia
Bladder retention
Spasticity

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.

Lenehan et al investigated the effects of age on clinical outcome in 50 patients with acute traumatic CCS. Patient ages at the time of injury were as follows: under 50 years, 13 patients; 50-70 years, 24 patients; and over 70 years, 13 patients. The incidence of sphincter disturbance among all patients was 42% on admission. Over a mean 42.2-month follow-up period, improvements in upper and lower limb motor scores, as well as in total sensory scores, occurred in patients in all age groups. However, the greatest improvements, absolute and relative, were found in patients under age 50 years. At follow-up, residual sphincter disturbance was found in 60% of patients over age 70 years but in no patients below age 70. The authors concluded that patients aged 70 years or above with acute traumatic CCS tend to have significantly poorer clinical outcomes than do younger patients with this syndrome.^[42]

In addition to younger age, favorable long-term prognostic factors in CCS also include good hand function, evidence of early motor recovery, documented increases in upper and lower extremity strength during initial rehabilitation, and an absence of lower extremity neurologic impairment at admission to rehabilitation.^{[17, 43, 44, 45]}

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.^[46]The authors determined, therefore, that for patients with CCS, length of spinal cord edema may provide a significant indication of prognosis.

A study by Zhang et al indicated that in patients with CCS, radiologically demonstrated cervical spinal cord stenosis of over 3.9 cm in length predicts a poor recovery (specificity 91.7%, sensitivity 52.2%), as does a Brain and Spinal Injury Center (BASIC) score of greater than 1 (specificity 80.5%, sensitivity 51.1%).^[47]

Patient Education

See the list below:

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.

Questions

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Media Gallery

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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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, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Additional Contributors

J Michael Wieting, DO, MEd, FAOCPMR, FAAOE Senior Associate Dean, Professor of Physical Medicine and Rehabilitation, Professor of Osteopathic Manipulative Medicine, Lincoln Memorial University-DeBusk College of Osteopathic Medicine

J Michael Wieting, DO, MEd, FAOCPMR, FAAOE is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Osteopathic Examiners, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Gold Humanism Honor Society, International Society for Communication Science and Medicine, Michigan Osteopathic Association, Oklahoma Osteopathic Association, Tennessee Osteopathic Medical Association

Disclosure: Nothing to disclose.