What is Central Cord Syndrome & How is it Treated?

Central Cord Syndrome is an incomplete type of spinal cord injury which is usually caused due to a trauma in which there is disruption of the signals which come and go from the brain and the spinal cord. Central Cord Syndrome results in severe impairment of the upper extremities including the arms and hands. The lower extremities may also be affected by this condition but it is to a much lesser extent.

As stated Central Cord Syndrome, causes impairment of the transmission of signal to and from the parts of the body which lie below the level of the injury but the signal is not completely blocked and hence Central Cord Syndrome is given the term as an incomplete injury. In Central Cord Syndrome, there is damage to the nerve fibers which carry information from the brain to the spinal cord.

The nerves which are damaged are extremely essential for the functioning of the upper extremities like the arm and the hands and thus Central Cord Syndrome may also in some case causes paralysis and/or impairment in fine motor control of the hands and arms. Central Cord Syndrome may also cause loss of sensation below the level of the spinal cord injury. It may also cause loss of bladder control but all of these symptoms depend on the extent of the injury and how much the nerve fibers are damaged.

As stated, above, the main cause for Central Cord Syndrome is an injury which is usually a hyperextension injury in an individual with a preexisting condition of cervical spondylosis. Since cervical spondylosis is mostly seen in the elderly population and hence Central Cord Syndrome is normally seen in this age group but there have been cases of Central Cord Syndrome in the younger population as well. In the younger population Central Cord Syndrome may occur due to a forced trauma to the cervical spine as a result of a motor vehicle collision causing hyperextension of the cervical spine. Also, people with an unstable cervical spine are also predisposed to have Central Cord Syndrome.

The classic presenting symptom of a Central Cord Syndrome is the presence of profound motor weakness of the upper extremities. There is weakness of the lower extremities as well but to a much less extent when compared to the upper extremities. There may also be loss of sensation of the upper extremities. Some patients may experience loss of bladder control due to Central Cord Syndrome while some patients may suffer from urinary retention. Central Cord Syndrome affects males more than females and is usually found in people above the age of 50, although it may occur in younger individuals as well.

The diagnosis of Central Cord Syndrome Evaluation begins with a complete and detailed history taking of the patient to look for any evidence of an injury to the cervical spine or if the patient has a history of cervical spine dislocation episodes in the past. This is followed by a thorough neurological examination in which the doctor will examine the patient’s strength, reflexes, and sensation in the affected upper extremities. Once Central Cord Syndrome is suspected then the doctor may order radiological studies like an MRI scan, CT scan, or a plain x-ray of the cervical spine to look at the internal structures of the cervical spine. These advanced studies will clearly show any damage to the muscle fibers in the cervical spine and thus confirm the diagnosis of Central Cord Syndrome.

The treatment for Central Cord Syndrome is two fold surgical and nonsurgical. Surgical treatment is done when there is severe compression of the cervical spine and the muscle fibers are acutely damaged. Through a surgical procedure the spine is decompressed and the muscle fiber repaired to restore normal functioning of the upper extremities and relief of other symptoms of Central Cord Syndrome.

If the symptoms are moderate and there is not a significant compression of the cervical spine then usually observation is the method of treatment for central cord syndrome. In most cases, there is significant neurological improvement observed with time resulting in significant relief of symptoms and return of motor function thus negating the need for surgery for treating Central Cord Syndrome. Some of the nonsurgical methods of treating Central Cord Syndrome are utilizing cervical collar for complete immobilization of the neck, using steroids, and rigorousphysical therapy for strengthening and stabilizing the spine so as to improve the symptoms caused by Central Cord Syndrome.

The prognosis of Central Cord Syndrome is quite good with majority of the patients, especially the younger population making complete recovery and return of motor function within six weeks of the injury. The functions of the leg returns first, followed by return of function of bladder, and then complete recovery of the function of the upper extremities.

The prognosis for the elderly population with central cord syndrome is somewhat guarded depending on the extent of the injury and how stable the cervical spine is and in some cases there might not be substantial improvement despite surgical and nonsurgical treatments for Central Cord Syndrome.