Acute central cervical cord injury presenting with only upper extremity involvement

Abstract

Twenty-four patients with acute central cervical cord injury with motor and sensory impairment involving only the upper extremities are described; none had any abnormality in the lower extremities. They were all treated conservatively with one exception in whom an anterior decompression was performed. Seventeen had complete recovery of motor function; the remaining 7 had some weakness of the palmar interosseous muscles. The time to recovery was from 2 weeks to 4 months. Sensory recovery took from 4 to 6 months after injury. This type of injury is caused by damage to the anterior and posterior horn cells in the cervical cord.

Dropped-head syndrome resulting from injury to the central spinal cord at the upper cervical level

“…A variety of neurological deficits and mechanisms of injury have been attributed to the central spinal cord. 9,13,20 Some authors [21][22][23][24] have argued that the somatisation of the upper cervical spine in higher mammals is less organised than originally outlined by Schneider et al 8 Others have questioned whether injuries to the upper cervical spinal cord actually reflect an injury to the decussation of the pyramids (Bell's cruciate paralysis) rather than an injury to the central cord. 10,25 Despite these discussions, the hallmark of injury to the central spinal cord has remained an injury to the cervical cord with disproportionate weakness in the upper limbs.…”

“…10,25 Despite these discussions, the hallmark of injury to the central spinal cord has remained an injury to the cervical cord with disproportionate weakness in the upper limbs. 8,9,[11][12][13][14]20 Several anatomical studies have tried to clarify the innervation of the musculature of the posterior cervical spine. 15,16 The major muscle groups which contribute to its stability and mobility consist of semispinalis capitis, semispinalis cervicis, multifidus, splenius capitis and splenius cervicis.…”

“…Other authors have extended these observations to include other osseoligamentous injuries as well as different neurological presentations. [9][10][11][12][13][14] The most central portions of the motor tracts of the spinal cord in the region of C1-2 supply the cervical paraspinal musculature and start to leave the spinal canal by the third cervical nerve root. [15][16][17] Thus, an injury to the central spinal cord above C3 would be expected to cause severe weakness of the cervical paraspinal musculature, potentially extending to the upper and lower limbs.…”