Central Cord Syndrome – The Most Common Spinal Cord Injury
Domlur, Bengaluru Feb 14, 2017
One of the most common form of cervical spinal cord injury – characterized by loss of motion and sensation in arms and hands. It usually results from trauma which causes damage to the neck, leading to major injury to the central grey matter of the spinal cord. The syndrome is more common in people over the age of 50 because osteoarthritis in the neck region causes weakening of the vertebrae. CCS most frequently occurs among older persons with cervical spondylosis, however, it also may occur in younger individuals.
CCS is the most common incomplete spinal cord injury syndrome. After an incomplete injury, the brain still has the capacity to send and receive some signals below the site of injury. Sending and receiving of signals to and from parts of the body is reduced, not entirely blocked. CCS gives a greater motor loss in the upper limbs than in the lower limbs, with variable sensory loss.
It is generally associated with favorable prognosis for some degree of neurological and functional recovery. However, factors such as age, pre-existing conditions, and extent of injury will affect the recovery process.
CCS is characterized by disproportionately greater motor impairment in upper compared to lower extremities, and variable degree of sensory loss below the level of injury in combination with bladder dysfunction and urinary retention. This syndrome differs from that of a complete lesion, which is characterized by total loss of all sensation and movement below the level of the injury.
Individuals with CCS can experience a reduction in their neurological symptoms with conservative management. Early immobilization of the cervical spine with a neck collar with bed rest is used to limit the potential of further injury. Cervical spine restriction is maintained for approximately six weeks until the individual experiences a reduction in pain and neurological symptoms. Inpatient rehabilitation is initiated in the hospital setting, followed by outpatient physical therapy to assist with recovery.
An individual with a spinal cord injury may have many goals for outpatient physiotherapy. Their level of independence, self-care, and mobility are dependent on their degree of neurological impairment. The physiotherapist works with the patient to develop specific, measurable, action-oriented, realistic, and time-centered goals.
With respect to physical therapy, repetitive task-specific sensory input can improve motor output in patients with central cord syndrome. These activities enable the spinal cord to incorporate both supraspinal and afferent sensory information to help recover motor output. This occurrence is known as “activity dependent plasticity”. Activity dependant plasticity is stimulated through such activities as: locomotor training, muscle strengthening, voluntary cycling, and functional electrical stimulation (FES).
Surgical intervention is carried out for those individuals who have increased instability of their cervical spine, which cannot be resolved by conservative management alone. Further indications for surgery include a neurological decline in spinal cord function in stable patients as well as those who require cervical spinal decompression.