Central Cord Syndrome

05 November 2004

Schneider, 1954

Incomplete, traumatic cervical cord syndrome

More motor impairment in upper compared to lower limbs

Bladder dysfunction (usually urinary retention)

Varying degrees of sensory loss below level of lesion

Presumably, ant compression from arthritic spur or herniated disc

                    Post compression from buckled lig flavum

Injury characteristics

44% motor vehicle accidents (usually young)

38% falls (usually elderly with cervical spondylosis)

12% sports & diving

4% gunshot

1% assault

63% associated with cervical vertebral #

Clinical

Upper limb weakness:               4% proximal alone

                                                36% distal alone

                                                60% proximal & distal

MRI:    T2 hyperintense signal (sensitivity 40-90%)

Prognosis (3 months post injury)

93% improved upper limb strength

91% improved lower limb strength

84% continent spontaneous voiding

Outcome predictors (for functional independence, continence, home discharge)

Younger age

Preinjury employment

Documented upper & lower limb strength improvement during admission

Good hand function

Treatment

Schneider:       

objected to surgical management as some cases showed rapid spontaneous clinical recovery

Those managed by laminectomy, pial incision over hematomyelia, myelotomy showed deterioration after surgery

Current indications for surgery:  persistent compression of spinal cord

                                                Unacceptable instability of cervical spine