Central cord syndrome

Central cord syndrome is the most common type of incomplete spinal cord syndrome and a common form of spinal cord injury, accounting for ~10% of all spinal cord injuries. As the name implies, this syndrome is the result of a contusion ofdamage to the central portion spinal cord and in the setting of trauma most commonly affects the cervical spinal cord.

Epidemiology

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. 

Clinical presentation

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.

Pathology

Central cord syndrome by definition primarily affects the centre of the spinal cord and is frequently haemorrhagic.

Mechanism

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.

Associations

• hyperextension teardrop fracture: can have associated acute traumatic CCS (ATCCS) in ~80% of cases ⁷

Radiographic features

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.

MRI

Findings depend upon the severity of trauma and presence of pre-existing canal stenosis, following features can be seen ¹¹:

• cord compression
• cord oedema
• cord haematoma: associated with poor prognosis

Signal characteristics

• 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.