Orthopaedic Jobs

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, & results in proportionally greater loss of motor function to upper extremities than
            lower extremities w/ 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 volunatary 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 central portion of corticospinal and spinothalamic long tracts in white matter produces upper motor neuron
            spastic paralysis of  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.     

Diagnosis and prognosis of acute cervical spinal cord injury.   



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, September 27, 2016 5:30 am