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Central Cord Syndrome by Mary Cresse

Definition

Central cord syndrome (CCS) is a type of incomplete spinal cord injury. CCS is marked by damage to the nerve fibers that bring messages from the brain to the body. This condition affects how you can use your arms and hands, and in some cases your legs. There is a loss of sensation and motor control.

Cervical Spine

Causes

CCS is caused by damage to the cervical spine, near the first seven vertebrae. This damage often occurs when the neck is hyperextended. This can cause the spinal cord to be compressed, which can lead to:

Loss of blood supply to the area
Bleeding in the spinal cord
Edema (swelling created by fluid in connective tissues)

Common causes of injury include:

Trauma (eg, car accident, sports injuries, falls)
Degenerative condition of spine (often found in older people)
Pre-existing condition, such as being born with a narrow spine

Risk Factors

These factors increase your chance of developing CCS:

Gender: male
Age: over 50 (more likely to have arthritis of the neck and a fall)
Pre-existing condition (eg, narrow spinal canal, spinal cord disease or dysfunction)
Participation in certain sports (eg, wrestling, diving)

Tell your doctor if you have any of these risk factors.

Symptoms

If you have any of these symptoms do not assume it is due to CCS. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

Inability to lift arms and hands completely, or numbness and tingling
Difficulty with fine motor control (eg, buttoning a shirt)
Muscle weakness in legs, difficulty walking
Loss of bladder control

If CCS is due to trauma, symptoms usually come quickly. Sometimes, however, symptoms may come more gradually.

Diagnosis

Your doctor will ask about your symptoms and medical history. In addition to doing a physical exam, she may also perform a neurologic exam, which includes assessing:

Reflexes
Mental state
Vision

Tests may include:

MRI scan —a test that uses magnetic waves to make pictures of structures inside the spinal cord
CT scan —a type of x-ray that uses a computer to make pictures of structures near and inside the spinal cord
Myelogram —imaging test that uses a special dye to view the spinal cord and the area surrounding it
X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones

Treatment

Talk with your doctor about the best treatment plan for you. If the injury is due to trauma, you may need to spend a number of weeks in the hospital. Rehab can take 1-2 months. If you are young and have more muscle tone at follow-up evaluation, you have a better chance of recovering. Other predictors of recovery are:

Muscle function at the time of the injury
Level of education

Treatment options include the following:

Nonsurgical Treatment

In most cases, surgery is not needed. Often treatment involves:

Immobilizing the neck
Giving steroids
Doing physical and occupational therapy

Surgery

Surgery is needed if there is significant compression of the spinal cord. At times, surgery may also be done after a period of recovery, for example, if you still have cord compression and no more recovery.

Prevention

To help reduce your chance of getting a spinal cord injury, take the following steps:

Avoid diving if you do not know how deep the water is.
Always wear a seatbelt.
Do not drink and drive. Do not ride with someone who has been drinking.
Remove obstacles in your house, like throw rugs, that could cause falls.
Use safe techniques and proper equipment when playing sports.
Secure firearms.

RESOURCES:

Christopher and Dana Reeve Foundation http://www.christopherreeve.org/
National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/
National Spinal Cord Injury Association http://www.spinalcord.org/

CANADIAN RESOURCES:

Canadian & American Spinal Research Organization http://www.csro.com/
Spinal Cord Injury Centre http://www.scrc.umanitoba.ca/

References:

Central cord syndrome. Neurosurgery Today.org website. Available at: http://www.neurosurgerytoday.org/what/patient_e/central_cord_syndrome_06.asp. Published November 2006 . Accessed November 20, 2008.
Check for safety: a home fall prevention checklist for older adults. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncipc/pub-res/toolkit/Falls_ToolKit/DesktopPDF/English/booklet_Eng_desktop.pdf. Published 2005 . Accessed November 13, 2008.
Clinical Syndromes. J Spinal Cord Med. 2007;30:215–224. Available at: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2031952&blobtype=pdf . Accessed December 7, 2008.
Cortez R, Levi AD. Acute Spinal Cord Injury. Current Treatment Options in Neurology . 2007;9:115-125. Available at: http://www.treatment-options.com/ . Accessed December 7, 2008.
Finnoff JT, Midlenberger D, Cassidy CD. Central cord syndrome in a football player with congenital spinal stenosis. Am J Sports Med. 2004;32:516-521.
NINDS central cord syndrome information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/central_cord/central_cord.htm . Updated October 2008. Accessed November 20, 2008.
Rich V, McCaslin E. Central cord syndrome in a high school wrestler: a case report. J Athl Train. 2006;41:341-344.
Spinal cord injuries. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated November 26, 2008. Accessed December 8, 2008.
Spinal cord injury. American Association of Neurological Surgeons website. Available at: http://www.spineuniverse.com/displayarticle.php/spinal-cord-3134.html . Updated October 2008. Accessed November 13, 2008.
Spinal cord injury (SCI): prevention tips. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncipc/factsheets/sciprevention.htm. Updated September 2006 . Accessed November 20, 2008.
Stedman’s Medical Dictionary . 28th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2005; 1001;1616;1893
Visocchi M, Di Rocco F, Meglio M. Subacute clinical onset of post-traumatic myelopathy. Acta Neurochir . 2003;145: 799-804.

Last reviewed September 2009 by Marcin Chwistek, MD

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