CENTRAL CORD SYNDROME
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What is Central Cord Syndrome?
Central Cord Syndrome is an injury that occurs to the spinal cord as it travels within the neck.
The spinal cord travels from the brain to the lower back within the spinal canal. Our spine is made of bones called vertebrae that are stacked on each other and are held in place by ligaments. Each vertebrae has a hole in its center, and all of these holes line up to form the spinal canal.
However, if an injury damages the ligaments, then a vertebrae can temporarily shift out of place, and now the holes dont line up. When the vertebrae moves it can bump into the spinal cord, thus injuring the cord.
Sometimes the bone (vertebrae) will remain out of position and stay pressed up against the spinal cord, pinching the cord.
The spinal cord is very sensitive and It will not function if injured. An injured spinal cord causes varying degrees of numbness and weakness in our arms and legs (depending on where along the spinal cord, the injury occurs).
In a Central Cord Syndrome, the upper extremity (hands and arms) is affected worse than the lower extremity. People will report partial or complete muscle weakness and numbness.
Central Cord Syndrome usually occurs in elderly people that already have underlying spinal canal narrowing due to arthritic changes in their neck (called "spinal stenosis"). Often times a small injury can make a narrow space even narrower (its like the straw that breaks the camels back). An acute injury to a chronic problem will cause a sudden and major spinal cord injury.
Essentially an arthritic spine cannot adjust to any type of traumatic injury, there is no wiggle room, and therefore the spinal cord gets compressed causing neurologic injuries.
How is Central Cord Syndrome diagnosed?
Patients will typically come into the emergency room because of the severity of the symptoms. They will have little or no function of their hands, and decreased function of their legs.
X-rays or a CT scan is important to look for injury to the bones (vertebrae). These tests can show if there is a vertebrae out of alignment, that is making the spinal canal too narrow.
However, an MRI is gives the best information about compression of the spinal cord. Its necessary for diagnosis and determining the best treatment options. The MRI will show bruising of the spinal cord or surrounding swelling.
How is Central Cord Syndrome treated?
Treatment depends on what the MRI findings and the severity of symptoms.
Most cases of Central Cord Syndrome will slowly improve if the patient is given time to recover. Therefore, many doctors will treat this injury non-surgically, and instead offer supportive care and physical therapy to speed up functional recovery.
However, if neurologic symptoms continue to worsen, then surgery will provide the best chance for improvement. Additionally, if the neurologic symptoms are stable but the MRI shows that one of the vertebrae is actively compressing the spinal cord, then a surgical decompression can be performed. Either an anterior (surgical approach through the front of the neck) or a posterior (approach from the back of the neck) decompression of the spinal canal can help with recovery.
What is the long term outcome?
Recovery is variable.
Usually clumsiness in the hands persists, but, the lower extremity recovers very well and people will regain function.
Unfortunately there is a lot of variability between patients regarding the amount of functional recovery.
Medicine doesnt fully understand why some people completely bounce back while others remain permanently impaired.