Central cord syndrome

Central cord syndrome (CCS) is the most common

form of cervical spinal cord injury. It is characterized
by loss of motor power and sensation in arms and hands.
It usually results from trauma which causes damage to the
neck, leading to major injury to the central grey matter.
It is more common in patients over the age of 50 because
osteoarthritis in the neck region, which causes weakening
of the vertebrae.

than destructive hematomyelia. More recently, autopsy

studies have demonstrated that CCS may be caused by
bleeding into the central part of the cord, portending less
favorable prognosis. Studies also have shown from postmortem evaluation that CCS probably is associated with
selective axonal disruption in the lateral columns at the
level of the injury to the spinal cord with relative preservation of the grey matter.[4]

The brain still has the capacity to send and receive signals
below the site of injury. It can send signals to and from
parts of the body but it is reduced not entirely blocked.
This gives a greater motor loss in the upper limbs than in
the lower limbs, with variable sensory loss.

3 Management

CCS most frequently occurs among older persons with

cervical spondylosis, however, it also may occur in
3.1
younger individuals.[1]

Nonsurgical

It was rst described by Schneider in 1954.[2] CCS is the

most common incomplete SCI syndrome. It accounts for
approximately 9% of traumatic SCIs.[3] It is generally associated with favorable prognosis for some degree of neurological and functional recovery. However, factors such
as age, preexisting conditions and extent of injury will
aect the recovery process.

In many cases, individuals with CCS can experience a reduction in their neurological symptoms with conservative
management. The rst steps of these intervention strategies include admission to an intensive care unit (ICU) after initial injury. After entering the ICU, early immobilization of the cervical spine with a neck collar would
be placed on the patient to limit the potential of further
injury.[5] Cervical spine restriction is maintained for approximately six weeks until the individual experiences a
1 Presentation
reduction in pain and neurological symptoms.[5] Inpatient
rehabilitation is initiated in the hospital setting, followed
It is characterized by disproportionately greater motor by outpatient physical therapy and occupational therapy
impairment in upper compared to lower extremities, and to assist with .
variable degree of sensory loss below the level of in- An individual with a spinal cord injury may have many
jury in combination with bladder dysfunction and urinary goals for outpatient occupational and physiotherapy.
retention.[4] This syndrome diers from that of a com- Their level of independence, self-care, and mobility are
plete lesion, which is characterized by total loss of all sen- dependent on their degree of neurological impairment.
sation and movement below the level of the injury.
Rehabilitation organization and outcomes are also based
on these impairments.[6] The physiatrist, along with the
rehabilitation team, work with the patient to develop
specic, measurable, action-oriented, realistic, and time2 Causes
centered goals.
In older patients, CCS most often occurs after a
hyperextension injury in an individual with long-standing
cervical spondylosis. However, this condition is not exclusive to older patients as younger individuals can also
sustain an injury leading to CCS. Typically, younger patients are more likely to get CCS as a result of a high-force
trauma or a bony instability in the cervical spine.[4][5]
Historically, spinal cord damage was believed to originate from concussion or contusion of the cord with stasis of axoplasmic ow, causing edematous injury rather

With respect to physical therapy interventions, it has been

determined that repetitive task-specic sensory input can
improve motor output in patients with central cord syndrome. These activities enable the spinal cord to incorporate both supraspinal and aerent sensory information to
help recover motor output.[7] This occurrence is known as
"activity dependent plasticity". Activity dependant plasticity is stimulated through such activities as: locomotor training, muscle strengthening, voluntary cycling, and
functional electrical stimulation (FES) cycling[8]
1

3.2

Surgical

Surgical intervention is usually given to those individuals who have increased instability of their cervical spine,
which cannot be resolved by conservative management
alone. Further indications for surgery include a neurological decline in spinal cord function in stable patients
as well as those who require cervical spinal decompression.[9]

See also
Rick Hansen Foundation
NINDS Spinal Cord Injury Information Page
Spinal cord injury
Anterior cord syndrome
Posterior cord syndrome
Brown-Sequard syndrome

References

[1] Rich V, McCaslin E (2006). Central Cord Syndrome in

a High School Wrestler: A Case Report. J Athl Train 41
(3): 3414. PMC 1569555. PMID 17043705.
[2] Schneider RC, Cherry G, Pantek H (1954). The
syndrome of acute central cervical spinal cord injury;
with special reference to the mechanisms involved in
hyperextension injuries of cervical spine. J. Neurosurg.
11 (6): 54677. doi:10.3171/jns.1954.11.6.0546. PMID
13222164.
[3] McKinley W, Santos K, Meade M, Brooke K (2007).
Incidence and Outcomes of Spinal Cord Injury Clinical
Syndromes. J Spinal Cord Med 30 (3): 21524. PMC
2031952. PMID 17684887.
[4] Harrop, James S; Ashwini Sharan; Jonathon Ratli
(2006). Central cord injury: pathophysiology, management, and outcomes. The Spine Journal 6 (6 Suppl. 1):
198S206S. doi:10.1016/j.spinee.2006.04.006. PMID
17097539.
[5] Nowak, Douglas D.; Joseph K. Lee; Daniel E. Gelb; Kornelis A. Poelstra; Steven C. Ludwig (December 2009).
Central Cord Syndrome. Journal of the American
Academy of Orthopaedic Surgeons 17 (12): 756765.
PMID 19948700.
[6] Behrman, Andrea, L.; Harkema, Susan J. (2007). Physical Rehabilitation as an Agent for Recovery After
Spinal Cord Injury. Physical Medicine and Rehabilitation Clinics of North America 18 (2): 183202.
doi:10.1016/j.pmr.2007.02.002. PMID 17543768.

REFERENCES

[7] Behram, A.L.; Harkema, S.J. (2007). Physical Rehabilitation as an Agent for Recovery After Spinal
Cord Injury.
Physical Medicine and Rehabilitation Clinics od North America 18 (2): 183202.
doi:10.1016/j.pmr.2007.02.002. PMID 17543768.
[8] Yadla, S.; Klimo, J.; Harrop, J.S. (2010). Traumatic
Central Cord Syndrome: Etiology, Management, and
Outcomes. Topics in Spinal Cord Injury Rehabilitation
15 (3): 7384. doi:10.1016/j.spinee.2006.04.006. PMID
17097539.
[9] Yadla, Sanjay; Paul Klimo; James S. Harrop (2010).
Traumatic Central Cord Syndrome: Etiology, Management, and Outcomes. Topics in Spinal Cord Injury Rehabilitation 15 (3): 7384. doi:10.1310/sci1503-73.

Bibliography
http://health.enotes.com/
neurological-disorders-encyclopedia/
central-cord-syndrome
http://www.ninds.nih.gov/disorders/central_cord/
central_cord.htm

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