Central cord syndrome is a distinct form of spinal cord injury affecting the neck region.
Understanding Central Cord Syndrome
Central cord syndrome (CCS) is the most common type of incomplete spinal cord injury, meaning the spinal cord’s ability to transmit signals is reduced, but not entirely blocked. It involves damage primarily to the central part of the cervical spinal cord in the neck. This central area contains nerve fibers responsible for movement and sensation. A characteristic of CCS is motor weakness where the upper extremities (arms and hands) are more significantly affected than the lower extremities (legs). This occurs because nerve tracts controlling arm and hand movements are located more centrally in the spinal cord. Sensory deficits, including changes in feeling, can also occur below the level of the injury.
Common Causes and Risk Factors
Central cord syndrome most frequently arises from hyperextension injuries of the neck, where the head is forcefully tilted backward. This often happens during falls, especially in older adults, causing the neck to extend sharply. The spinal cord can then be squeezed between existing bony spurs or disc material at the front and the ligamentum flavum at the back of the spinal canal.
Pre-existing conditions significantly increase the risk of developing CCS. Cervical spondylosis, a common age-related arthritis of the neck, can narrow the spinal canal, making the spinal cord more vulnerable to compression even from minor trauma. Over 90% of CCS patients over 40 years old have underlying cervical spine conditions. While more common in older individuals, younger people can also sustain CCS from high-force trauma, such as motor vehicle accidents or sports injuries, which may cause bony instability or herniated discs in the cervical spine.
Recognizing the Symptoms
A prominent feature of central cord syndrome is disproportionately greater weakness and loss of fine motor control in the arms and hands compared to the legs. This can make everyday tasks such as buttoning clothes, writing, or grasping objects very difficult.
Sensory changes are also common and can include numbness, tingling, or a loss of sensation to pain and temperature. These sensory deficits often appear in a “cape-like” or “suspended” distribution across the shoulders and upper back, extending down the arms. Bladder dysfunction, often manifesting as difficulty with urination or urinary retention, can occur. Some individuals may also experience neuropathic pain, described as burning or shooting sensations, and neck pain at the site of the spinal cord impingement.
Diagnosis and Immediate Care
Diagnosing central cord syndrome involves a thorough medical evaluation, beginning with a detailed neurological examination to assess motor strength, sensation, and reflexes in all four limbs. Imaging studies are then performed to visualize the spinal cord and surrounding structures. Magnetic Resonance Imaging (MRI) is the primary diagnostic tool, providing detailed images of the spinal cord to identify swelling, bruising, or direct compression from bone, disc material, or blood clots. Computed Tomography (CT) scans are also used to assess bony structures and detect any fractures or dislocations in the vertebrae.
Immediate medical management focuses on stabilizing the patient and preventing further injury. This includes immobilizing the cervical spine, often with a rigid collar, to limit neck movement. While corticosteroids, such as methylprednisolone, were historically used to reduce inflammation, their benefit in acute spinal cord injury is currently debated, and high-dose infusions are generally no longer considered standard care.
Rehabilitation and Long-Term Outlook
Comprehensive rehabilitation is a cornerstone of treatment for central cord syndrome, aiming to maximize functional recovery and improve daily living. This multidisciplinary approach involves various therapies. Physical therapy focuses on regaining strength, improving mobility, and enhancing balance, particularly in the lower limbs and trunk, to aid ambulation. Occupational therapy helps individuals relearn and adapt strategies for daily activities, such as dressing, eating, and personal hygiene, often incorporating assistive devices. Speech therapy may also be included if swallowing or voice issues arise.
Surgical intervention may be considered when there is persistent spinal cord compression from a herniated disc or bony instability, or if neurological function worsens. While the timing of surgery remains a subject of ongoing discussion, some studies suggest that early surgical decompression within 24 hours may lead to better outcomes for certain patients. Many patients with mild symptoms may initially undergo conservative management with immobilization and rehabilitation.
The recovery pattern in central cord syndrome often follows a predictable sequence. Leg strength tends to recover first, enabling individuals to regain the ability to walk. This is often followed by the return of bladder control.
Improvement in arm and hand strength usually occurs later, with fine motor skills and dexterity in the hands often being the slowest and most challenging functions to fully regain. Many individuals with CCS experience significant neurological recovery, especially younger patients, with some regaining nearly normal function. However, some may have residual deficits, particularly in hand function, necessitating long-term adaptation strategies and continued rehabilitation efforts to maximize independence. The most significant recovery often occurs within the first six months after injury.