Central cord syndrome is more common among elderly perspms with long-standing cervical spondylosis but it can occur in younger persons with injuries.
Location of fibers in the spinal cord
Fibers carrying the motor and sensory impulses for lower limbs are located in the most peripheral part of the cord, whereas fibers carrying impulses for the upper limb and voluntary bowel and bladder function are more centrally located. Sacral tracts are located most peripherally & are usually spared from injury.
Causes
Central cord syndrome is usually the result of trauma to the spinal cord. The commonest mode of injury is hyperextension in a patient with long-standing cervical spondylosis. The spinal cord is pinched by the ligamentum flavum or anterior compression by the osteophytes.
Sometimes, central cord syndrome may be a result of fracture dislocation and compression fracture, especially if the spinal cord is congenitally narrow. Central cord syndrome can also be caused by hematomas and blood build-up.
Symptoms
- Trauma - usually falls
- Weakness in limbs
- Some loss of feeling (this varies from person to person)
- Loss of pain and temperature sensation
- Loss of sensation of light touch and position
Site of lesion in CCS
The disproportionate motor involvement observed in central cord syndrome is due to location of nerve fibres and tracts and is consistent with the lamination pattern of the tracts in the spinal cord.
Diagnosis
X-rays: Fracture and dislocation can be diagnosed and flexion/extension view will be helpful in diagnosing stability of ligaments.
CT scan: CT scan of cervical spine may show a narrow spinal canal.
MRI scan: MRI can show the presence of hematoma, impingement from bone or intervertebral disc. More on pathophysiology and presentation of SCI
Treatment
There is no cure for central cord syndrome. Treatment is usually supportive and includes medical and surgical treatment as well as physical therapy. Indications for surgery are rare and need for surgical treatment has to be individualized. Physical therapy mainly helps to preserve the range of motion.
Prognosis
Prognosis for central cord syndrome is variable. Patient receiving early treatment recover better. Walking is recovered in most cases with some residual disability. Improvement starts in the legs, followed by the bladder and is lastly seen in the arms.