Central cord syndrome
Encyclopedia
Central cord syndrome is an acute cervical
spinal cord injury
(SCI) that can affect a large and diverse group of patients. It was first described by Schneider in 1954.
It has been reported that CCS most frequently occurs among older persons with cervical spondylosis, however, it also may occur in younger individuals.
CCS is the most common incomplete SCI syndrome. It accounts for approximately 9% of traumatic SCIs. It is generally associated with favorable prognosis for some degree of neurological and functional recovery. However, factors such as age, preexisting conditions and extent of injury will affect the recovery process.
, which is characterized by total loss of all sensation and movement below the level of the injury.
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and occupational therapy
to assist with muscle retraining. In particular, regaining hand functionality and improving gait is usually the focus of the treatment as CCS generally affects both upper and lower extremities. However, the patient will ultimately decide the focus of the physical therapy treatment, as goals of regaining functionality are highly specific to the individual.
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Cervical vertebrae
In vertebrates, cervical vertebrae are those vertebrae immediately inferior to the skull.Thoracic vertebrae in all mammalian species are defined as those vertebrae that also carry a pair of ribs, and lie caudal to the cervical vertebrae. Further caudally follow the lumbar vertebrae, which also...
spinal cord injury
Spinal cord injury
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
(SCI) that can affect a large and diverse group of patients. It was first described by Schneider in 1954.
It has been reported that CCS most frequently occurs among older persons with cervical spondylosis, however, it also may occur in younger individuals.
CCS is the most common incomplete SCI syndrome. It accounts for approximately 9% of traumatic SCIs. It is generally associated with favorable prognosis for some degree of neurological and functional recovery. However, factors such as age, preexisting conditions and extent of injury will affect the recovery process.
Presentation
It is characterized by disproportionately greater motor impairment in upper compared to lower extremities, and variable degree of sensory loss below the level of injury in combination with bladder dysfunction and urinary retention. This syndrome differs from that of a complete lesionLesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
, which is characterized by total loss of all sensation and movement below the level of the injury.
Causes
In older patients, CCS most often occurs after a hyperextension injury in an individual with long-standing cervical spondylosis. However, this condition is not exclusive to older patients as younger individuals can also sustain an injury leading to CCS. Typically, younger patients are more likely to get CCS as a result of a high-force trauma or a bony instability in the cervical spine. Historically, spinal cord damage was believed to originate from concussion or contusion of the cord with stasis of axoplasmic flow, causing edematous injury rather than destructive hematomyelia. More recently, autopsy studies have demonstrated that CCS may be caused by bleeding into the central part of the cord, portending less favorable prognosis. Studies also have shown from postmortem evaluation that CCS probably is associated with selective axonal disruption in the lateral columns at the level of the injury to the spinal cord with relative preservation of the grey matterGrey matter
Grey matter is a major component of the central nervous system, consisting of neuronal cell bodies, neuropil , glial cells and capillaries. Grey matter contains neural cell bodies, in contrast to white matter, which does not and mostly contains myelinated axon tracts...
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Nonsurgical Management
In many cases, individuals with CCS can experience a reduction in their neurological symptoms with conservative management. The first steps of these intervention strategies include admission to an intensive care unit (ICU) after initial injury. After entering the ICU, early immobilization of the cervical spine with a neck collar would be placed on the patient to limit the potential of further injury. Cervical spine restriction is maintained for approximately six weeks until the individual experiences a reduction in pain and neurological symptoms. Inpatient rehabilitation is initiated in the hospital setting, followed by outpatient physical therapyPhysical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
and occupational therapy
Occupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
to assist with muscle retraining. In particular, regaining hand functionality and improving gait is usually the focus of the treatment as CCS generally affects both upper and lower extremities. However, the patient will ultimately decide the focus of the physical therapy treatment, as goals of regaining functionality are highly specific to the individual.
Surgical Management
Surgical intervention is usually given to those individuals who have increased instability of their cervical spine, which cannot be resolved by conservative management alone. Further indications for surgery include a neurological decline in spinal cord function in stable patients as well as those who require cervical spinal decompressionSpinal decompression
Spinal decompression is a term that describes the relief of pressure on one or many pinched nerves of the spinal column.Spinal decompression can be achieved both surgically and non-surgically and is used to treat conditions that result in chronic back pain such as disc bulge, disc herniation,...
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See also
- Spinal cord injurySpinal cord injuryA spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
- Anterior cord syndromeAnterior cord syndromeAnterior cord syndrome is a medical condition where the blood supply to the anterior portion of the spinal cord is interrupted. It is characterized by loss of motor function below the level of injury, loss of sensations carried by the anterior columns of the spinal cord , and preservation of...
- Posterior cord syndromePosterior cord syndromePosterior cord syndrome is a condition caused by lesion of the posterior portion of the spinal cord. It can be caused by an interruption to the posterior spinal artery.Unlike anterior cord syndrome, it is a very rare condition....
- Brown-Sequard syndromeBrown-Séquard syndromeBrown-Séquard syndrome, also known as Brown-Séquard's hemiplegia and Brown-Séquard's paralysis, is a loss of sensation and motor function that is caused by the lateral hemisection of the spinal cord...