CENTRAL CORD SYNDROME

REVIEW ARTICLE

(Nowak DD, Lee JK, Gelb DE, Poelstra KA, Ludwig SC)

CLAUDIA M.F.K.FAQI NURDIANSYAHOTTO PARANDANGI

RUMONDANG NAIBAHOSYUKRI LARANTI

TUTOR :Dr. JECKY CHANDRA

Central Cord Syndrome

CCS is the most common type of incomplete SCI (15-25% of all cases).

First described by Schneider et al5 in 1954.

Central Cord Syndrome

Classic CCS presents as underlying cervical spondylosis in the older patient (aged >60 years) who sustains a hyperextension injury without any evidence of damage to the bony spine.

CCS occurs in younger persons who sustain higher-energy trauma resulting in spinal fractures or instability.

Anatomy

SCI Mechanism• onset: at the time of trauma• caused : directly excessive

flexion, extension, and/or rotation of the spinal cord.

• indirectly by displaced bone or disk material having an impact on the spinal cord.

Primary

• Onset : after the inciting traumatic event.

• caused : an incompletely understood complex reaction involving a combination of an inflammatory response and neuronal cell apoptosis .

Secondary

Etiology of CCS

Trauma•Trauma is the most common cause of CCS.•High Energy Incident

Non-trauma•CCS can also result from nontraumatic causes, such as spinal epidural abscess.•Classic CC:older patient with underlying cervical spondylosis who sustains an injury as the result of hyperextension of the head and neck relative to the torso.

Risk Factor of CCS

• Age > 40 years old• There is pre-existing canal stenosis or spondylosis.

Pathology of CCS

Old Theory•Consist of injury to the central gray matter & the central portion of the long tracts, with preservation of the peripheral structures. Injury to the central gray matter and cord hemorrhage main causes of CCS.

Recent Theory

•MRI & two autopsy studies found no evidence of lower motor neuron injury or cord parenchyma hemorrhage diffuse injury to the large diameter motor axons in the lateral corticospinal tract was noted.

Characteristic of CCS

CCS presents on a spectrum, from weakness limited solely to the hands and forearms with sensory preservation, to complete quadriparesis with sacral sparing as the only evidence of incomplete SCI.

Motor function return, if any occurs, proceeds in a caudad to cephalad manner.

Diagnosis

Diagnosis

X-Ray

MRI

Determine the extent of

neurologic injurySacral sparing

CT-Scan

MRI

Management

Non-Surgical

• Early immobilization and rehabilitation

• Monitoring hemodynamic

• Maintain MABP > 85 mmHg

• Intravenous steroids Controversy

Surgical• Spinal instability is the only absolute indication for surgical intervention

• In traumatic CCS, early surgical intervention ≤24 hours of injury has better outcome

• Immediately indication acute dislocation and progressive neurologic deficit.

PrognosisYoung age, Preinjury employment, Level of education, Absence of abnormality shown by MRI,Higher initial ASIA motor score, Absence of spasticity, Early motor recovery, Good hand function.

Spinal column instability, Degree of canal stenosis, Persistent spasticity, Medical comorbidities

Summary CCS is the most common incomplete SCI.With the

increasing age of the population, physicians will be encountering more patients with CCS.

All CCS patients should receive optimal medical management and early immobilization.

Early surgical treatment is recommended in the absence of spinal instability in the patient with neurologic deterioration.

Further research is needed to determine the best treatment algorithm and the timing of surgical intervention, if chosen, for any nonprogressive neurologic deficit that remains static.

THANK YOU