Central Cord Syndrome

Central Cord Syndrome (CCS) refers to an incomplete injury to the cervical spinal cord. This injury typically results in more extensive motor weakness in the upper extremities than the lower extremities, with the hands being preferentially affected. CSS commonly results from a hyperextension injury in a patient who has a narrow spinal canal. The spinal cord is squeezed, leading to swelling, bleeding and/or insufficient blood flow to the central portion of the spinal cord. Patients typically develop weakness of the arms and hands with weakness that is usually milder in the legs. Some sensory loss below the level of the injury may occur, and bladder symptoms (such as urinary retention) may be experienced as well. CCS may occur in patients of any age. It is sometimes seen in young athletes, but this syndrome more commonly affects people age 50 and older who have sustained a hyperextension injury of their neck.

Spinal Treatment

An immediate spine operation is not usually necessary unless there is significant cord compression. Surgery is usually not performed until the patient has made maximum recovery. Reassessment at that time may lead to surgery, depending on the underlying cause. Nonsurgical treatment consists of immobilization of the neck with a cervical collar; steroids, if appropriate; and physical therapy.

Outcome

If the underlying cause is edema, recovery may occur relatively soon after the initial onset of weakness. Leg function usually returns first, followed by bladder control and then arm function. Hand movement and finger dexterity improve last. If the central lesion is caused by hemorrhage (bleeding into the spinal cord) or ischemia (insufficient blood flow to the spinal cord), then recovery is less likely.

In some patients, loss of hand function can be permanent because of loss of motor neurons. This results in loss of innervation to the corresponding muscles – a situation that clinically is similar to a peripheral nerve injury. Of patients with severe weakness affecting the hands, about 4-10% recover reasonable function over time.

Reconstructive Neurosurgery

Such hand weakness can be corrected with nerve transfers or tendon transfers. Our center recommends an evaluation with electromyography (EMG) and nerve conduction studies by 3 months after the injury. If severe denervation is documented, the patient may be a candidate for nerve transfers to restore this function. As with other nerve injuries, if this intervention is not undertaken until after 1 year, the likelihood of recovering good hand function is not good. Tendon transfers might be considered in this situation.