Central Cord Syndrome

Central cord syndrome (CCS) is a type of cervical spinal cord injury, which was first reported in 1954 by Richard Schneider and his colleagues. CCS is characterized by loss of bladder control, inhibited motor function disproportionately affecting the upper limbs, and some degree of sensory impairment below the level of injury. In this article, we'll describe exactly what central cord syndrome is, how it's diagnosed, and how it can be treated.

What Is Central Cord Syndrome?

Central cord syndrome is a type of incomplete trauma to the spinal cord with which the patient will often have problems with moving their arms, hands and, to a lesser degree, their legs. This is because certain signals carried
from the brain to the body aren't being properly transmitted. However, these signals have not been completely blocked.

The condition is usually due to injury to the large nerve fibers which transmit signals to the spinal cord from the cerebral cortex. These nerves are essential for proper hand and arm movement. Patients may find that their arms have become paralyzed or that they have lost fine motor control in the hands, for example, when buttoning a shirt. They may not be able to lift their hands and arms completely, and can feel tingling or numbness in the arms. If the legs are also affected, they will experience weakness in the muscles and trouble walking. Depending on the extent of the nerve damage, patients may also lose control of their bladder, or have sensory dysfunction below the level of injury.

If the CCS is caused by injury, the symptoms can develop suddenly. However, they may, in certain cases, appear more gradually.

What Causes Central Cord Syndrome?

CCS develops when there is trauma to the central region of the spinal cord. The damage usually happens when the neck is bent back or hyperextended. This is often linked with:

  • Swelling
  • Bleeding into the spinal cord
  • Reduced blood supply to the region
  • The development of spinal cord cysts – a condition known as Syringomyelia (syrinx)

Other frequent causes of CCS include:

  • Trauma, in particular traffic accidents, falls, and sports injuries
  • Spine degeneration. This is most often seen in the elderly
  • Existing health conditions, such as congenital narrowness of the spine
  • Structural issues with the spine and tumors within the spinal cord can also give rise to CCS

Risk Factors of Central Cord Syndrome

The chances of developing CCS are increased by the following factors:

  • Age over 50
  • Male
  • Practicing particular sports, for instance, diving or wrestling
  • Autoimmune conditions, such as neuromyelitis optica and multiple sclerosis
  • Previous health problems, for example, a tethered cord or spinal cord disease

How to Diagnose Central Cord Syndrome

Your doctor will usually take your complete medical history and perform a comprehensive neurological examination. The cervical spine can be viewed with various kinds of scan:

  • MRI involves taking three-dimensional pictures using strong magnets and computer systems. It can explicitly confirm bone-, disc-, or hematoma-mediated spinal cord impingement.
  • CT: In this process, a computer produces a diagnostic image from X-rays of the spine. This can reveal the size, shape and contents of the spinal canal as well as the surrounding structures.
  • X-ray radiation can produce an image or a film of the spinal region, showing the vertebral structure and joint borders. This way, your doctor can delineate any dislocations or fractures in the spine, and visualize the extent of spondylitic change. The stability of the spinal ligaments may be assessed with flexion and extension-view X-rays.

How Is Central Cord Syndrome Treated?

It is possible to treat central cord syndrome, although there is no definite cure. Treatment can vary–there is no standard program–but it often consists of drug, surgery, rest, or a combination of these techniques.

1. Non-Surgical Methods

Many people with CCS decrease their neurological symptoms with conservative therapy.

  • Inpatient treatment. The first stage of CCS treatment following the initial trauma often involves a period in intensive care. Here, the cervical spine is immobilized using a neck collar to prevent further damage to the spine. This immobilization will continue for about 6 weeks until there is an improvement in neurological symptoms and decreased pain. Rehabilitation usually starts in the inpatient hospital setting.
  • Outpatient treatment. Once the patient is ready to be discharged from the inpatient ward, they often undergo both physical and occupational therapy. The exact regime depends on the extent of the injury and the patient's goals. The treatment will also take into account their mobility and ability to take care of themselves. The objectives of these therapies should be specific, measurable, action-orientated, realistic and time-centered.

Movement in patients with CCS can be improved using repetitive task-specific sensory input. This allows the spinal cord to integrate supraspinal and afferent sensory input to promote the motor response. The process is termed activity-dependent plasticity and can involve voluntary cycling, functional electrical stimulation cycling, strengthening of the muscles and locomotor training.

2. Surgical Methods

If you have greater cervical spine instability and won't gain much benefit from conventional treatment alone, you may need an operation. Surgery may also be performed for those who have deteriorating neurological spinal cord function or have compressed spinal cord fibers. You may need surgery after a period of recovery; for instance, if the cord is still compressed, you may receive spinal decompression.

3. Prevention Methods

The following tips will cut your risk of injury to the spinal cord:

  • Wear a seatbelt whenever you're in a vehicle.
  • Don't ever drive under the influence of drugs or alcohol, or ride in a car where the driver is intoxicated.
  • Be careful when cycling or walking along roads.
  • Don’t dive into water if you're unsure of the depth.
  • Rearrange any objects in your house that could cause you to trip, such as wires and loose rugs.
  • Secure or turn in any firearms in your house.
  • When playing sport, always use the right equipment and safe methods.

The Outcome of Central Cord Syndrome Treatment

Will a person with central cord syndrome recover completely? Here let's look at the outcomes of accepting central cord syndrome treatment.

  • Spontaneous recovery of motor functions is often seen in CCS patients. Others may experience marked improvement over the 6 weeks following injury. However, the prognosis largely depends on the cause of the CCS.
  • CCS resulting from edema may lead to initial paralysis or pareses followed by a relatively quick recovery, starting from the legs, then a regain in bladder control and the return of function to the arms. Restoration of hand motility is usually the final stage of recovery.
  • If the main injury is due to hemorrhage or ischemia, the prognosis is usually a lot worse, and the chances of recovery are a lot smaller.
  • Younger patients with CCS can generally expect a good recovery. Most young people with CCS will eventually be able to walk again and perform everyday actions. Unfortunately, the prognosis is not so good for elderly patients, even with surgical intervention.
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