Central cord syndrome (CCS) is a type of incomplete spinal cord injury. It involves damage to the center of the cervical spinal cord, which is the portion located in the neck. This injury disrupts nerve signals that travel between the brain and the body. In CCS, the innermost nerve fibers are the most affected. This specific pattern of damage leads to a distinct set of symptoms, and it is the most common form of incomplete spinal cord injury.
Causes and Risk Factors
The most frequent cause of central cord syndrome is a hyperextension injury, where the neck is abruptly and forcefully tilted backward. This trauma often occurs during motor vehicle accidents or from falls, which are a common cause in older adults. The forceful movement can squeeze the spinal cord, leading to bruising, swelling, or bleeding within its central region.
This condition is most prevalent in individuals over 50 with pre-existing degenerative conditions of the cervical spine. Conditions such as cervical spondylosis (age-related wear of spinal discs) and spinal stenosis (a narrowing of the spinal canal) make the cord more vulnerable. These changes reduce the space for the spinal cord, meaning even a minor traumatic event can cause significant injury by compressing the cord. In these instances, there may not be an obvious fracture of the neck bones.
Identifying the Symptoms
The most prominent feature of central cord syndrome is greater motor weakness in the arms and hands compared to the legs. This occurs because the nerve fibers that control the arms are located more centrally within the spinal cord, while those for the legs are situated more toward the outside. Individuals with CCS may be able to walk but struggle with tasks requiring arm and hand function.
Fine motor skills of the hands and fingers are often severely impacted. Patients may find it difficult to perform tasks like buttoning a shirt, writing, or holding utensils.
Beyond motor deficits, sensory changes are also common, including numbness, tingling sensations, or a persistent burning or dull ache below the level of the injury. Bladder dysfunction is another symptom. Some individuals may experience urinary retention, an inability to empty their bladder completely.
The Diagnostic Process
Confirming a diagnosis of central cord syndrome begins with a thorough neurological examination. A physician will assess motor function by testing the strength in the arms and legs. This evaluation also includes testing sensory perception to identify areas of numbness or altered sensation, along with checking reflexes to understand the extent of the nerve signal disruption.
Imaging studies are used to visualize the structures of the neck and spinal cord. Magnetic Resonance Imaging (MRI) is the primary diagnostic tool because it provides detailed images of soft tissues. An MRI can reveal swelling, bleeding (hemorrhage), or direct damage to the spinal cord itself.
In addition to MRI, Computed Tomography (CT) scans and X-rays are frequently employed. These studies assess the bony structures of the cervical spine. They can identify any fractures in the vertebrae or show degenerative changes like bone spurs that may have contributed to the injury.
Approaches to Treatment
The management of central cord syndrome often begins with non-surgical interventions. A patient’s neck is immobilized with a rigid cervical collar to prevent further movement and potential damage to the spinal cord. Corticosteroids may be administered to help reduce swelling and inflammation. Physical and occupational therapy helps patients regain strength, improve motor control, and relearn how to perform daily activities.
Surgical intervention is considered for patients who show persistent compression of the spinal cord or instability in their cervical spine. It is also an option for a significant or worsening neurological decline. The primary goal of surgery is to decompress the spinal cord, which involves removing whatever is pressing on it, such as a herniated disc or a piece of bone. This creates more space for the spinal cord, which can alleviate pressure and allow for better neurological recovery.
Recovery and Outlook
The prognosis for individuals with central cord syndrome is more favorable compared to other types of spinal cord injuries. Many patients experience a substantial recovery of neurological function, especially within the first six weeks following the injury. The extent of recovery is, however, highly variable and depends on several factors.
Recovery follows a predictable pattern. Function in the legs returns first, often allowing patients to regain the ability to walk. This is followed by the return of bladder control. Improvement in arm and hand function comes last, and the recovery of fine motor skills is often the most challenging and may remain incomplete.
Several factors influence the long-term outlook. The patient’s age is a predictor, with younger individuals having better outcomes. The initial severity of the injury is also a factor; those with less severe initial symptoms tend to recover more fully. The presence of pre-existing conditions like spinal stenosis can also impact the degree of recovery. If the injury was caused by swelling that resolves, the prognosis is better than if it was caused by bleeding within the cord.