Central cord syndrome
Central cord syndrome is the most common type of incomplete spinal cord injury, accounting for ~10% of all spinal cord injuries. As the name implies, this syndrome is the result of a contusion of the central portion of the cervical spinal cord.
Most often central cord syndrome occurs in older individuals with underlying cervical spondylosis. However, it may also be seen in younger persons who sustain trauma to the cervical spine, for example during forceful football tackling such as when a player "spears" another with their head.
Patients present with upper limb weakness, urinary retention (due to bladder dysfunction) and sensory loss below the level of the injury. The upper extremities are classically more affected than the lower extremities, with motor function more severely impaired than sensory function.
Central cord syndrome by definition primarily affects the centre of the spinal cord and is frequently haemorrhagic.
A hyperextension cervical injury is the most common mechanism for central cord syndrome, however, it can be seen with other mechanisms including flexion. Occasionally it may be associated more chronically with syrinx and/or intramedullary spinal cord tumours 8.
- hyperextension teardrop fracture: can have associated acute traumatic CCS (ATCCS) in ~80% of cases 7
Plain radiograph and CT
May be normal, show spondylosis, acquired/congenital canal stenosis, or fracture. The presence of an extension teardrop fracture should be a warning sign.
Findings depend upon the severity of trauma and presence of pre-existing canal stenosis, following features can be seen 11:
- T1: the affected region is usually of isointense signal compared to rest of cord
- T2: increased signal centrally within the cord at the affected level (oedema/contusion)
History and etymology
Central cord syndrome was first described by R C Schneider et al. in 1954 1.
- 1. 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. 1954;11 (6): 546-77. doi:10.3171/jns.1954.11.6.0546 - Pubmed citation
- 2. Quencer RM, Bunge RP, Egnor M et-al. Acute traumatic central cord syndrome: MRI-pathological correlations. Neuroradiology. 1992;34 (2): 85-94. - Pubmed citation
- 3. Nowak DD, Lee JK, Gelb DE et-al. Central cord syndrome. J Am Acad Orthop Surg. 2009;17 (12): 756-65. J Am Acad Orthop Surg (full text) - Pubmed citation
- 4. Miyanji F, Furlan JC, Aarabi B et-al. Acute cervical traumatic spinal cord injury: MR imaging findings correlated with neurologic outcome--prospective study with 100 consecutive patients. Radiology. 2007;243 (3): 820-7. doi:10.1148/radiol.2433060583 - Pubmed citation
- 5. Collignon F, Martin D, Lénelle J et-al. Acute traumatic central cord syndrome: magnetic resonance imaging and clinical observations. J. Neurosurg. 2002;96 (1 Suppl): 29-33. - Pubmed citation
- 6. Martin D, Schoenen J, Lenelle J et-al. MRI-pathological correlations in acute traumatic central cord syndrome: case report. Neuroradiology. 1992;34 (4): 262-6. - Pubmed citation
- 7. Rao SK, Wasyliw C, Nunez DB. Spectrum of imaging findings in hyperextension injuries of the neck. Radiographics. 25 (5): 1239-54. doi:10.1148/rg.255045162 - Pubmed citation
- 8. Ostrander L. "The Spinal Cord Injured Patient Comprehensive Management, Second Edition". Demos Medical. (2002) ISBN:188879951X. Read it at Google Books - Find it at Amazon
- 9. 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. 1954;11 (6): 546-77. doi:10.3171/jns.1954.11.6.0546 - Pubmed citation
- 10. 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. Free text at pubmed - Pubmed citation
- 11. Dai L. Magnetic resonance imaging of acute central cord syndrome: correlation with prognosis. Chin. Med. Sci. J. 2003;16 (2): 107-10. Pubmed citation