Central Cord Syndrome

Discussion:

Most common incomplete cord lesion

Frequently associated w/ extension injury to osteoarthritic spine (cervical spondylosis) in middle aged person who sustains hyperextension injury; - cord is injured in central gray matter, which results in proportionally greater loss of motor function to upper extremities than lower extremities with variable sensory sparing;

Anatomy: - fibers responsible for lower extremity motor and sensory functions are located in the most peripheral part of the cord; - whereas fibers controlling the upper extremity and voluntary bowel and bladder function are more centrally lcoated; - sacral tracts are positioned on the periphery of the cord & are usually spared from injury;

Mechanism of Injury: - hyperextension injury w/ pinching of spinal cord between ligamentum flavum & intervertebral disc & posterior vertebral body bone spurs; - central cord injury and hemorrhage occur with compression of adjacent white-matter tracts; - more peripheral positioning of lower extremity axons within the spinal cord tracts accounts for the injury pattern; - damage to the central portion of the corticospinal and spinothalamic long tracts in white matter produces upper motor neuron spastic paralysis of the trunk and lower extremity; - impact damage to grey matter, produced by pincer effect of osteophytes anteriorly & infolded ligamentum flavum posteriorly, produces severe flaccid lower motor neuron paralysis of fingers, hands, and arms;

Exam: - central cord syndrome is remarkable for more cord involvement in the upper extremities than in the lower extremities; - manifests w/ loss of distal upper extremity pain & temperature sensation and strength, w/ relative preservation of lower extremity strength & sensation,

Upper extremities: - mixed upper and lower-motor-neuron lesion, w/ partial flaccid paralysis of upper extremities (indicative of involvement of lower motor neurons); - prognosis is variable w/ poor hand function;

Lower extremities: - spastic paralysis of lower extremities (indicative of involvement of upper motor neurons) - bladder and bowel function may also be lossed;

Radiographs: - X-ray may reveal no fx or dislocation; - SCIWORA syndrome;

Prognosis: - majority of patients will achieve functional walking w/ progressive return of motor and sensory power to the lower extremities and trunk (gait may be spastic); - tend to have poor recovery of hand function owing to irreversible central gray matter destruction; - these pts are likely to regain bowel and bladder function;

Incomplete traumatic quadriplegia: A ten year review. A. Bosh et al. JAMA. Vol 216. 1971. p 473-478. Diagnosis and prognosis of acute cervical spine cord injury. ES Stauffer. CORR. Vol 112. 1975. p 9-15.