Central cord syndrome is the most common type of incomplete spinal cord syndrome, usually the result of trauma, accounting for ~10% of all spinal cord injuries. As the name implies, this syndrome is the result of a damage to the central portion spinal cord and in the setting of trauma most commonly affects the cervical cord.
Most often central cord syndrome occurs in the setting of trauma, and most offed older individuals with underlying cervical spondylosis. However, it may also be seen in younger persons who sustain substantial trauma to the cervical spine, for example during forceful football tackling such as when a player "spears" another with their head.
Central cord syndrome is also seen in spinal cord tumors and other non-traumatic conditions (see below), and the epidemiology will match that of the underlying condition.
The pattern of neurological deficit in patients with central cord syndrome depends on the size of the injury which in turn affects which parts of the spinal cord are involved.
In smaller central lesions the spinothalamic tract fibers that cross the anterior white mater commissure are interrupted resulting in bilateral pain and temperature loss at the affected levels 12. Below these levels, cord function is intact. As the cervical region is most commonly affected, the neurological defect described as affecting a "cape" distribution (both arms and shoulders and upper chest but sparing the rest of the body) 12.
In larger lesions, other parts of the cord are involved, including the corticospinal tracts, spinothalamic tracts, dorsal columns and spinal grey matter. The result is upper motor neuron pattern of deficit below the level of injury (due to interruption of descending corticospinal tracts) - spastic paralysis and urinary retention - and lower motor neurone pattern of deficit at the levels of injury (due to damage to the anterior horn cells) 12. The upper extremities are classically more affected than the lower extremities (due to upper limb fibers being located more centrally) with motor function more severely impaired than sensory function 12.
Central cord syndrome is most often the result of trauma but can also be seen in a variety of non-traumatic cord pathologies including:
- intramedullary spinal cord tumors (e.g. spinal ependymoma)
- syringohydromyelia (e.g. Chiari I malformation)
These are discussed separately, in their respective articles.
A hyperextension cervical injury in individuals with degenerative canal stenosis is the most common mechanism for central cord syndrome, and in such cases, the cord is pinched between disk and/or osteophytes anteriorly and ligamentum flavum hypertrophy posteriorly 12. Hyperextension teardrop fracture have associated acute traumatic central cord syndrome in ~80% of cases 7.
Other mechanisms including flexion, fracture dislocation and acute disk herniation can also result in a central cord syndrome and these are seen more frequently in younger individuals 12.
Plain radiograph and CT
Osseous imaging may be normal, show spondylosis, acquired/congenital canal stenosis, or fracture.
The presence of an extension teardrop fracture should be a warning sign.
Findings depend upon the severity of trauma and presence of pre-existing canal stenosis, following features can be seen 11:
Typically the cord will demonstrate the following signal characteristics:
- the affected region is usually of isointense signal compared to rest of cord or slightly hypointense
- hemorrhagic contusion may have areas of high T1 signal
- increased signal centrally within the cord at the affected level (edema/contusion)
- hemorrhagic contusions will have variable signal with areas of low T2 eventually becoming apparent
- T2* - SWI/GE: will show low signal and blooming if blood product
History and etymology
Central cord syndrome was first described by R C Schneider et al. in 1954 1.
- 1. Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J. Neurosurg. 1954;11 (6): 546-77. doi:10.3171/jns.1954.11.6.0546 - Pubmed citation
- 2. Quencer RM, Bunge RP, Egnor M et-al. Acute traumatic central cord syndrome: MRI-pathological correlations. Neuroradiology. 1992;34 (2): 85-94. - Pubmed citation
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- 4. Miyanji F, Furlan JC, Aarabi B et-al. Acute cervical traumatic spinal cord injury: MR imaging findings correlated with neurologic outcome--prospective study with 100 consecutive patients. Radiology. 2007;243 (3): 820-7. doi:10.1148/radiol.2433060583 - Pubmed citation
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- 6. Martin D, Schoenen J, Lenelle J et-al. MRI-pathological correlations in acute traumatic central cord syndrome: case report. Neuroradiology. 1992;34 (4): 262-6. - Pubmed citation
- 7. Rao SK, Wasyliw C, Nunez DB. Spectrum of imaging findings in hyperextension injuries of the neck. Radiographics. 25 (5): 1239-54. doi:10.1148/rg.255045162 - Pubmed citation
- 8. Ostrander L. "The Spinal Cord Injured Patient Comprehensive Management, Second Edition". Demos Medical. (2002) ISBN:188879951X. Read it at Google Books - Find it at Amazon
- 9. SCHNEIDER RC, CHERRY G, PANTEK H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J. Neurosurg. 1954;11 (6): 546-77. doi:10.3171/jns.1954.11.6.0546 - Pubmed citation
- 10. McKinley W, Santos K, Meade M et-al. Incidence and outcomes of spinal cord injury clinical syndromes. J Spinal Cord Med. 2007;30 (3): 215-24. Free text at pubmed - Pubmed citation
- 11. Dai L. Magnetic resonance imaging of acute central cord syndrome: correlation with prognosis. Chin. Med. Sci. J. 2003;16 (2): 107-10. Pubmed citation
- 12. Kunam VK, Velayudhan V, Chaudhry ZA, Bobinski M, Smoker WRK, Reede DL. Incomplete Cord Syndromes: Clinical and Imaging Review. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (4): 1201-1222. doi:10.1148/rg.2018170178 - Pubmed