Central Cord Syndrome

Epidemiology

 

Most common pattern cord injury

 

Hyper-extension injury in middle aged man with osteoarthritic spine

 

Usually C3/4 and C4/5

 

Mechanism

 

Most common type / in older patient with pre-existing spondylosis / OPLL

- hyperextension injury

- compression of the cord

- anteriorly by osteophytes

- posteriorly by infolded ligamentum flavum

 

Pathology

 

Injury of central gray matter

- weaker in arms than legs

- LMN in arms 

- UMN in legs

- sacral sparing common

 

Examination

 

Flaccid paralysis in upper limbs

 

Spastic paralysis in lower limbs

- more likely to be preserved

 

Xray

 

Typically normal / no fractures

 

MRI

 

Demonstrates stenosis

 

Cord

- high signal intensity on T2

- localise level of injury

 

Management

 

NHx

 

Usually regain walking and bladder function

Hands have the worst prognosis

 

Prognosis

 

Aarabi et al J Neurosurg Spine 2011

- 42 patients, 82% men, average age 58

- admission ASIA scores and midsagittal diameter of cord most related to prognosis

 

Issue

 

Decompression v non operative management

 

Surgical Timing

 

Chen et al J Neurosurg Spine 2009

- review of surgical decompression in 49 patients

- no difference between decompression < 4 days or > 4 days

- younger patients did significantly better

- 1/3 patients dissatisfied with outcome

 

Algorithm

 

Observe initially

- maximise medical treatment / HTN / oxygenation

 

If improving

- non operative

 

No improvement

- operative management