Central cord syndrome

Background
Spinal cord tracts

Etiology
  • Hyperextension injury of cervical spine
  • Disruption of blood flow to the spinal cord
  • Cervical spinal stenosis
  • Typically elderly patient with significant DJD (ligamentum flavum compresses cord, causing contusion to central portion of spinal cord)
  • Syringomyelia (progressive, chronic, pain/temperature loss first)
  • Central canal ependymoma

Clinical Features
  • Quadriparesis (characteristically worse function in upper extremities than lowers)
  • Rare: loss of pain/temperature sensation in upper > lower extremities
  • +/- bladder dysfunction/urinary retention
  • Has better outcomes than other cord syndromes

Differential Diagnosis

Spinal Cord Syndromes

Evaluation
  • MRI for direct evidence for impingement
  • CT may show central canal stenosis with indirect estimation of impingement

Management
  • Consider intubation injuries at C5 or above
  • Consider surgical intervention for:
  • Steroids are no longer recommended
    • Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is not Food and Drug Administration (FDA) approved for this application. There is no Class I or Class II medical evidence supporting the clinical benefit of MP in the treatment of acute SCI. Scattered reports of Class III evidence claim inconsistent effects likely related to random chance or selection bias. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death.[1]
    • See EBQ:High Dose Steroids in Cord Injury for further discussion

Disposition
  • Admission for acute injury
  • Surgery within 24 hours is safe and effective, but may be extended to < 2 weeks after injury[2]

See Also

References
  1. Hurlbert RJ et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery. 2013 Mar;72 Suppl 2:93-105 http://www.ncbi.nlm.nih.gov/pubmed/23417182
  2. Anderson KK et al. Optimal Timing of Surgical Decompression for Acute Traumatic Central Cord Syndrome: A Systematic Review of the Literature. Neurosurgery. 2015 Oct;77 Suppl 4:S15-32.
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