From the Research
Central cord syndrome is a type of incomplete spinal cord injury characterized by disproportionate weakness in the upper extremities compared to the lower extremities, as defined by a widely accepted criterion of ≥10 motor points in favor of the lower extremities 1.
Definition and Pathophysiology
Central cord syndrome (CCS) is the most common form of incomplete traumatic spinal cord injury, with a clinical phenomenon characterized by disproportionately greater motor impairment of the upper than of the lower extremities, and bladder dysfunction 2. The condition occurs because the central part of the spinal cord contains nerve fibers that control hand and arm function, which are more vulnerable to compression and injury.
Clinical Presentation
Patients with CCS present with weakness that is more pronounced in the arms and hands than in the legs, along with variable sensory loss and bladder dysfunction. The syndrome presents a spectrum, from weakness limited to the hands and forearms with sensory preservation, to complete quadriparesis with sacral sparing as the only evidence of incomplete spinal cord injury 3.
Treatment and Management
Treatment of CCS depends on the severity and may include immobilization with a cervical collar, corticosteroids like methylprednisolone, surgical decompression for progressive neurological deterioration or significant spinal instability, and comprehensive rehabilitation 1. Recovery is often gradual, with leg function typically improving first, followed by bladder control, and finally hand and finger dexterity, though complete recovery varies among patients.
Key Considerations
The diagnosis of CCS is dependent on neurological examination and imaging studies, and the treatment should be individualized based on the injury mechanism, compressive lesions, neurological examination, preexisting cervical pathology, and patient-specific comorbidities 2. Recent reports have recommended revisiting the terminology and criteria of CCS as existing definitions do not capture the entire essence of the syndrome 1.