Central spinal cord syndrome is the most common type of incomplete spinal cord injury, meaning the cord’s ability to send nerve signals below the site of damage is reduced but not lost. This condition involves damage to the central gray matter of the spinal cord, most frequently in the cervical region of the neck. The injury disrupts the large nerve fibers that transmit movement commands from the brain’s cerebral cortex to the spinal cord.
Causes and Risk Factors
Central spinal cord syndrome can arise from traumatic events or develop from non-traumatic conditions. A primary cause is trauma, particularly a hyperextension injury where the neck is abruptly bent backward. This injury is frequently seen after falls, especially in older adults, and in motor vehicle accidents. The sudden motion can cause damage to the vertebrae or lead to a herniation of the vertebral discs, which then impinge upon the spinal cord.
The syndrome may also develop in individuals over 50 due to pre-existing degenerative changes. Conditions like cervical spondylosis, a form of age-related arthritis in the neck, and spinal stenosis lead to a narrowing of the spinal canal. This narrowing makes the spinal cord more susceptible to injury from even minor trauma.
Characteristic Symptoms
Central spinal cord syndrome characteristically results in motor deficits that are more pronounced in the upper extremities than in the lower ones. This occurs because the nerve fibers controlling the arms and hands are located more centrally within the spinal cord, the primary site of damage. The nerves that control the legs are situated more toward the outside of the cord and are often less affected.
An individual might retain the ability to walk, sometimes with an unsteady gait, while experiencing profound weakness or paralysis in the arms and hands. This weakness severely impacts fine motor skills, making tasks like buttoning a shirt, writing, or using utensils difficult.
In addition to motor deficits, individuals often experience sensory disturbances below the level of the injury. These can include a loss of sensation or altered sensations such as numbness, tingling, or burning feelings. Bladder dysfunction is another frequent symptom, often presenting as urinary retention, and some may also experience bowel or sexual function changes.
The Diagnostic Process
Confirming a diagnosis of central spinal cord syndrome involves a clinical evaluation and advanced medical imaging. The process begins with a physical and neurological examination, where a physician assesses motor strength, tests for sensory deficits, and checks reflexes. This exam helps identify the classic pattern of greater weakness in the arms compared to the legs.
Following the clinical assessment, medical imaging is used to visualize the spinal cord. Magnetic Resonance Imaging (MRI) is the primary diagnostic tool because it provides detailed images of soft tissues. An MRI can show spinal cord compression and reveal swelling, bleeding, or bruising, which helps confirm the location and extent of the damage.
A Computed Tomography (CT) scan may also be performed to identify any fractures or dislocations in the cervical vertebrae. In some cases, specialized X-rays that capture the neck in flexion and extension are used to assess the stability of the spine.
Treatment and Management Approaches
The management of central spinal cord syndrome is tailored to the individual, involving non-surgical and surgical methods. Initially, many patients are managed conservatively, especially with evidence of neurological improvement. Non-surgical treatment begins with immobilizing the neck using a rigid cervical collar to prevent further damage, and medications may be administered to manage specific symptoms.
If a patient’s neurological condition worsens, fails to improve, or if imaging reveals persistent spinal cord compression or instability, surgery is considered. The primary goal of surgery is to relieve pressure on the spinal cord. A common procedure is a decompressive laminectomy, where a portion of the vertebra called the lamina is removed to create more space. In other cases, spinal fusion may be performed to stabilize the spine and protect the cord from further injury.
Recovery and Prognosis
The prognosis for central spinal cord syndrome is more favorable than for many other spinal cord injuries, with a significant number of patients regaining substantial function. Recovery follows a predictable pattern: function returns to the legs first, followed by improvements in bladder control. Motor function in the arms tends to recover next, with the fine motor skills of the hands and fingers being the last and most challenging to restore.
The extent and speed of recovery are influenced by several factors:
- Age, as younger patients have a better prognosis than older individuals.
- The severity of the initial injury, because those with less severe symptoms tend to recover more function.
- The underlying cause, as recovery may be faster if symptoms were from swelling that subsides compared to bleeding within the cord.
Intensive rehabilitation is necessary to maximize functional independence. A comprehensive program includes both physical and occupational therapy. Physical therapy focuses on improving strength, coordination, and mobility, particularly in the legs for walking. Occupational therapy is directed at regaining arm and hand function for daily living activities.