Central Cord Syndrome Follow-up: Further Outpatient Care, Further Inpatient Care, Inpatient & Outpatient Medications

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Central Cord Syndrome

Sections Central Cord Syndrome
Overview
Presentation
- History
- Physical
- Causes
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DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
References

Follow-up

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.^[38]

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.^[39]

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.^{[10, 40, 41, 42]}

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.^[43]The authors determined, therefore, that for patients with CCS, length of spinal cord edema may provide a significant indication of prognosis.

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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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].
Aito S, D'Andrea M, Werhagen L, et al. Neurological and functional outcome in traumatic central cord syndrome. Spinal Cord. 2007 Apr. 45(4):292-7. [Medline].
Chen LF, Chang HK, Chen YC, et al. Five-year medical expenses of central cord syndrome: analysis using a national cohort. J Neurosurg Sci. 2016 Oct 19. [Medline].
Thompson C, Mutch J, Parent S, Mac-Thiong JM. The changing demographics of traumatic spinal cord injury: An 11-year study of 831 patients. J Spinal Cord Med. 2015 Mar. 38 (2):214-23. [Medline]. [Full Text].
Passias PG, Poorman GW, Segreto FA, et al. Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013. World Neurosurg. 2018 Feb. 110:e427-37. [Medline].
Jain A, Brooks JT, Rao SS, Ain MC, Sponseller PD. Cervical fractures with associated spinal cord injury in children and adolescents: epidemiology, costs, and in-hospital mortality rates in 4418 patients. J Child Orthop. 2015 Jun. 9 (3):171-5. [Medline]. [Full Text].
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. 2006 Feb. 65(2):117-23. [Medline].
Schroeder GD, Kepler CK, Hjelm N, Vaccaro AR, Weinstein MS. The effect of vertebral fracture on the early neurologic recovery in patients with central cord syndrome. Eur Spine J. 2015 May. 24 (5):985-9. [Medline].
Dai L. Magnetic resonance imaging of acute central cord syndrome: correlation with prognosis. Chin Med Sci J. 2001 Jun. 16(2):107-10. [Medline].
Schroeder GD, Hjelm N, Vaccaro AR, Weinstein MS, Kepler CK. The effect of increased T2 signal intensity in the spinal cord on the injury severity and early neurological recovery in patients with central cord syndrome. J Neurosurg Spine. 2016 May. 24 (5):792-6. [Medline].
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. 2008 Jun. 89(6):1074-82. [Medline].
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). 2009 Aug. 24(7):551-7. [Medline].
Chen L, Yang H, Yang T, et al. Effectiveness of surgical treatment for traumatic central cord syndrome. J Neurosurg Spine. 2009 Jan. 10(1):3-8. [Medline].
Anderson KK, Tetreault L, Shamji MF, et al. Optimal Timing of Surgical Decompression for Acute Traumatic Central Cord Syndrome: A Systematic Review of the Literature. Neurosurgery. 2015 Oct. 77 Suppl 4:S15-32. [Medline].
Stevenson CM, Dargan DP, Warnock J, et al. Traumatic central cord syndrome: neurological and functional outcome at 3 years. Spinal Cord. 2016 Nov. 54 (11):1010-5. [Medline].
Yoshihara H, Yoneoka D. Trends in the treatment for traumatic central cord syndrome without bone injury in the United States from 2000 to 2009. J Trauma Acute Care Surg. 2013 Sep. 75(3):453-8. [Medline].
Brodell DW, Jain A, Elfar JC, et al. National trends in the management of central cord syndrome: an analysis of 16,134 patients. Spine J. 2014 Sep 28. [Medline].
Dahdaleh NS, Lawton CD, El Ahmadieh TY, et al. Evidence-based management of central cord syndrome. Neurosurg Focus. 2013 Jul. 35(1):E6. [Medline].
Jin W, Sun X, Wang J, et al. Recurrent Neurologic Deterioration After Conservative Treatment for Acute Traumatic Central Cord Syndrome without bony injury: 17 operative cases report. J Neurotrauma. 2016 Nov 14. [Medline].
Kepler CK, Kong C, Schroeder GD, et al. Early outcome and predictors of early outcome in patients treated surgically for central cord syndrome. J Neurosurg Spine. 2015 Oct. 23 (4):490-4. [Medline].
Park MS, Moon SH, Lee HM, et al. Delayed surgical intervention in central cord syndrome with cervical stenosis. Global Spine J. 2015 Feb. 5(1):69-72. [Medline]. [Full Text].
Samuel AM, Grant RA, Bohl DD, et al. Delayed surgery after acute traumatic central cord syndrome is associated with reduced mortality. Spine (Phila Pa 1976). 2015 Mar 1. 40 (5):349-56. [Medline].
Wilson JR, BSc LT, Aarabi B, et al. 181 Guidelines for the Management of Patients With Spinal Cord Injury: The Optimal Timing of Decompression. Neurosurgery. 2016 Aug. 63 Suppl 1:172. [Medline].
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. 1990 May 17. 322(20):1405-11. [Medline].
Bracken MB, Shepard MJ, Holford TR, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA. 1997 May 28. 277 (20):1597-604. [Medline].
Hadley MN, Walters BC, Grabb PA, et al. Pharmacological Therapy after Acute Cervical Spinal Cord Injury. Neurosurgery. 2002 Mar 1. 50 (suppl_3):S63-S72. [Medline].
Hurlbert RJ, Hadley MN, Walters BC, et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery. 2013 Mar. 72 Suppl 2:93-105. [Medline]. [Full Text].
Sayer FT, Kronvall E, Nilsson OG. Methylprednisolone treatment in acute spinal cord injury: the myth challenged through a structured analysis of published literature. Spine J. 2006 May-Jun. 6 (3):335-43. [Medline].
[Guideline] Fehlings MG, Tetreault LA, Wilson JR, et a;. A Clinical Practice Guideline for the Management of Acute Spinal Cord Injury: Introduction, Rationale, and Scope. Global Spine J. 2017 Sep. 7 (3 Suppl):84S-94S. [Medline]. [Full Text].
Haller H, Leblhuber F, Trenkler J, et al. Treatment of chronic neuropathic pain after traumatic central cervical cord lesion with gabapentin. J Neural Transm. 2003 Sep. 110(9):977-81. [Medline].
Lenehan B, Street J, O'Toole P, et al. Central cord syndrome in Ireland: the effect of age on clinical outcome. Eur Spine J. 2009 Oct. 18(10):1458-63. [Medline].
Wirz M, Zorner B, Rupp R, et al. Outcome after incomplete spinal cord injury: central cord versus Brown-Sequard syndrome. Spinal Cord. 2009 Nov 10. [Medline].
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). 2010 Mar 11. [Medline].
Anderson DG, Sayadipour A, Limthongkul W, Martin ND, Vaccaro A, Harrop JS. Traumatic central cord syndrome: neurologic recovery after surgical management. Am J Orthop (Belle Mead NJ). 2012 Aug. 41(8):E104-8. [Medline].
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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, FAAPMR Senior Associate Dean, Interim Dean of Clinical Medicine, 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, FAAPMR 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.

Sections Central Cord Syndrome
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
References

Central Cord Syndrome Follow-up

Further Outpatient Care

Further Inpatient Care

Inpatient & Outpatient Medications

Complications

Prognosis

Patient Education

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Central Cord Syndrome Follow-up

Further Outpatient Care

Further Inpatient Care

Inpatient & Outpatient Medications

Complications

Prognosis

Patient Education

References

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