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Central Cord Syndrome

(CCS; Central Cervical Cord Syndrome; Central Cord Injury; Injury, Central Cord; Paralysis, Upper Extremity; Syndrome, Central Cord; Syndrome, Central Cervical Cord; Upper Extremity Paralysis; Acute Central Cord Syndrome)

Pronounced: SEN-tral CORD SIN-droh-m

Definition

Central cord syndrome (CCS) is a type of incomplete spinal cord injury. CCS is marked by damage to the nerve fibers that bring messages from the brain to the body. This condition affects how you can use your arms and hands, and in some cases, your legs. There may be a loss of sensation and motor control.

Spinal Cord

Causes

CCS is caused by damage to the central part of the spinal cord. This damage may occur when the neck is hyperextended. This can can be associated with:

Syringomyelia (syrinx)—a cyst in the spinal cord
Loss of blood supply to the area
Bleeding in the spinal cord
Swelling

Common causes of injury include:

Trauma (eg, car accident, sports injuries, falls)
Degenerative condition of spine (often found in older people)
Pre-existing condition, such as being born with a narrow spine

CSS can also be due to:

Structural problems
Tumors within the spinal cord

Risk Factors

Males over 50 are more likely to have this condition. Risk factors that increase your chances of developing CCS include:

Autoimmune disorder (eg, multiple sclerosis, neuromyelitis optica)
Pre-existing condition (eg, narrow spinal canal, spinal cord disease, tethered cord)
Participation in certain sports (eg, wrestling, diving)

Symptoms

If you have any of these symptoms, do not assume it is due to CCS. These symptoms may be caused by other conditions.

Unable to lift arms and hands completely, or numbness and tingling
Difficulty with fine motor control (eg, buttoning a shirt)
Muscle weakness in legs, difficulty walking
Loss of bladder control

If CCS is due to trauma, symptoms usually come quickly. Sometimes, however, symptoms may come more slowly.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. A neurologic exam may also be done.

Your doctor may want pictures of your spinal cord. These can be taken with:

Treatment

Talk with your doctor about the best treatment plan for you. Rehab can take a long time for some patients. If you are young and have more muscle function, you have a better chance of recovering.

Treatment options include the following:

In most cases, surgery is not needed. Often treatment involves:

Restricting neck movement
Giving steroids
Doing physical and occupational therapy

Surgery is needed if there is a large compression of the spinal cord fibers. Surgery may also be done after a period of recovery. For example, if you still have cord compression after a recovery period.

Prevention

To help reduce your chance of getting a spinal cord injury, take the following steps:

Avoid diving if you do not know how deep the water is.
Always wear a seatbelt.
Do not drink and drive. Do not ride with someone who has been drinking.
Remove obstacles in your house, like throw rugs, that could cause falls.
Use safe methods and proper equipment when playing sports.
Secure firearms.

Christopher and Dana Reeve Foundation

http://www.christopherreeve.org/

National Institute of Neurological Disorders and Stroke

http://www.ninds.nih.gov/

National Spinal Cord Injury Association

http://www.spinalcord.org/

Canadian & American Spinal Research Organization

http://www.csro.com/

Spinal Cord Research Centre

http://www.scrc.umanitoba.ca/

Check for safety: a home fall prevention checklist for older adults. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncipc/pub-res/toolkit/Falls_ToolKit/DesktopPDF/English/booklet_Eng_desktop.pdf. Published 2005. Accessed November 27, 2012.

Clinical Syndromes. J Spinal Cord Med. 2007;30:215-224.

Cortez R, Levi AD. Acute Spinal Cord Injury. Current Treatment Options in Neurology. 2007;9:115-125.

Finnoff JT, Midlenberger D, Cassidy CD. Central cord syndrome in a football player with congenital spinal stenosis. Am J Sports Med. 2004;32:516-521.

NINDS central cord syndrome information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/central_cord/central_cord.htm. Updated September 27, 2011. Accessed November 27, 2012.

Rich V, McCaslin E. Central cord syndrome in a high school wrestler: a case report. J Athl Train. 2006;41:341-344.

Spinal cord injury—acute management. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 13, 2012. Accessed November 27, 2012.

Spinal cord injury—chronic management. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 6, 2012. Accessed November 27, 2012.

Spinal cord injury center. American Association of Neurological Surgeons website. Available at: http://www.spineuniverse.com/displayarticle.php/spinal-cord-3134.html. Updated November 9, 2009. Accessed November 27, 2012.

Spinal cord injury (SCI): prevention tips. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncipc/factsheets/sciprevention.htm. Updated November 21, 2012. Accessed November 27, 2012.

Visocchi M, Di Rocco F, Meglio M. Subacute clinical onset of post-traumatic myelopathy. Acta Neurochir. 2003;145: 799-804.

Last reviewed March 2013 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.