Central Cord Syndrome

A form of incomplete spinal cord injury due to hyperextension often presenting

with upper extremity motor weakness in older individuals. Surgical treatment and
early intervention are controversial.

Overview

• Presentation ranges from distal UE weakness to quadriparesis

• Most patients affected have compression of cord in addition to predisposing
decreased canal volume from spondylosis and osteophytes, stenosis, or OPLL
• Sacral sparing, and therefore incomplete spinal cord injury
• If motor status resolves, UE function last to return and often only partial hand
functional improvement

History

• Mechanism of injury?
• Prior neck pain or stiffness?
• Neurologic deficits? Location/levels of deficits?

Physical Exam

• Trauma evaluation (Appendix A)

• Complete neurologic evaluation (Appendix A)

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• Sacral sparing (signifies incomplete SCI—see chapter “Incomplete Spinal Cord

Injury”)

° FHL motor function

° Anal sphincter contraction
° Peri-anal sensation

Imaging

• C-spine XRs—AP, lateral, open mouth (odontoid) views

° Chronic cervical spondylosis

• CT—better assessment of bony injury or other concomitant spinal fractures

° Visualize entire spine with XR and/or CT

• MRI cord signal change indicating edema without hemorrhage

° r/o soft-tissue disruption

Management

Non-operative Treatment

° Rigid cervical immobilization

– Prevent motion injury
– 6 weeks or until resolution of pain and neurologic symptoms

° ICU monitoring with MAP >85 mmHg

– Maximal cord perfusion to improve chance for neurologic recovery

° Consider IV steroids
° Early neurologic improvement and absence of MRI cord signal changes are posi-
tive prognostic factors

Operative Treatment

• Trend towards surgery for central cord syndrome *IMPORTANT*

• Extent of decompression and stabilization dependent on pathology
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• Indications:

° Progressive neurologic deficit

° Cervical instability
° Structural cord compression—address spondylosis or chronic stenosis
• Results:

° Best results in younger patients and those with compressive lesions

° Unclear whether differences in outcomes between early and delayed surgery
° However, STASCIS trial showed benefit of surgery <24 h after cervical spinal
cord injury—so consider early intervention

References

Fehlings MG, Vaccaro A, Wilson JR, Singh A, W. Cadotte D, Harrop JS, et al. Early versus delayed
decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute
Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7(2):1–8.
Nowak DD, Lee JK, Gelb DE, Poelstra KA, Ludwig SC. Central cord syndrome. J Am Acad
Orthop Surg. 2009;17:756–65. PMID: 19948700.
Park MS, Moon S, Lee H, Kim T, Oh JK, Suh B, et al. Delayed surgical intervention in central cord
syndrome with cervical stenosis. Global Spine J. 2015;5:69–72.
Riew KD, Kang DG. Central cord syndrome: is operative treatment the standard of care? Spine
J. 2015;15(3):443–5.