Central cord syndrome

Central cord syndrome (CCS) is an acute cervical spinal cord injury (SCI). It was first described by Schneider in 1954.

CCS has been reported to occur more frequently among older persons with cervical spondylosis, but it also may occur in younger individuals.

CCS is the most common SCI syndrome. It accounts for approximately 9% of traumatic SCIs. It is generally associated with favorable prognosis for some degree of neurologic and functional recovery. CCS predominantly affects men more than women, similar to all other SCI.

Presentation

It is characterized by disproportionately greater motor impairment in upper compared to lower extremities, bladder dysfunction, and variable degree of sensory loss below the level of injury. This syndrome is unlike a complete lesion, that causes loss of all sensation and movement below the level of the injury.

Causes

CCS most often occurs after hyperextension injury in an individual with long-standing cervical spondylosis. 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 that CCS probably is associated with axonal disruption in the lateral columns at the level of the injury to the spinal cord with relative preservation of the grey matter.