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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


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