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CENTRAL CORD SYNDROMEHari Prakash Bharathi

Group 4Year 6

Department of Rehabilitation and Physical MedicineTbilisi State Medical University

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INTRODUCTION

an acute cervical spinal cord injury is marked by a disproportionately greater impairment of motor function in the upper extremities than in the lower ones,

as well as by bladder dysfunction and a variable amount of sensory loss below the level of injury.

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CAUSES

The most common cause of central cord syndrome (CCS) is trauma.

In older adults, premorbid cervical spondylosis is a significant risk factor.

Accordingly, even minor falls may result in tetraplegia in populations with a narrowed spinal canal.

In younger age groups, CCS results from major trauma, such as that associated with cervical fracture/subluxations.

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PATHOPHYSIOLOGY

Central cord syndrome (CCS) most often occurs after a hyperextension injury in an individual with long-standing cervical spondylosis.

Injury may result from posterior pinching of the cord by a buckled ligamentum flavum or from anterior compression of the cord by osteophytes.

Spinal cord damage originate from concussion or contusion of the cord with stasis of axoplasmic flow, causing edematous injury rather than destructive hematomyelia.

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PATHOPHYSIOLOGY

CCS may be caused by bleeding into the central part of the cord, portending a less favorable prognosis.

CCS 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.

The syndrome may be associated with fracture dislocation and compression fracture, especially in a congenitally narrowed spinal canal.

 These anteroposterior compressive forces also distribute the greatest damaging effect on the central mass of the cord substance.

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SYMPTOMS Symptoms of central cord syndrome occur following trauma (most

commonly falls) and consist of upper and lower extremity weakness, with varying degrees of sensory loss.

Pain and temperature sensations, as well as the sensation of light touch and of position sense, may be impaired below the level of injury.

Neck pain and urinary retention are common.

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REHABILITATION

Physical therapyOccupational therapySpeech therapyRecreational therapy

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PHYSICAL THERAPY

Aim: To preserve range of motion (ROM) and the enhancement of mobility skills

The strengthening of any preserved lower extremity musculature is essential, as are trunk balance and stabilization.

Patients with CCS offer a unique challenge for the physical therapist with regard to ambulation and gait training.

Despite the usual preservation of some lower extremity strength, upper extremity deficits can limit the use of possible assistive devices and, ultimately, the functional quality of ambulation. 

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OCCUPATIONAL THERAPY Aim: To restoration of the basic activities of daily living (ADLs),

upper extremity strength, and ROM. Splinting is used to maintain the functional position of the hand

and to prevent the formation of contractures in the fingers. Surface electromyelogram (EMG) biofeedback can often be

beneficial to patients in the isolation of specific weak muscles in the upper extremities.

Facilitating self-care skills by selecting appropriate assistive devices and training patients in their usage is another priority.

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SPEECH THERAPY

A speech therapist should be involved in the treatment of patients with central cord syndrome who have dysphagia from the head position maintained by cervical orthoses or as a result of anterior cervical spine fusion.

Various compensatory strategies need to be taught to these patients to make swallowing safer and to prevent aspiration.

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RECREATIONAL THERAPY

Aim: To help patients to return to preinjury areas of interest.

Potential sources of recreational activities are explored with the patient, and the adaptive devices (for instance, an adapted fishing rod) that will allow the individual to enjoy previous activities are explored and provided.

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THANK YOU