Acute traumatic central cord syndrome: A comprehensive review

Abstract

Acute traumatic central cord syndrome (ATCCS) is the most common type of incomplete spinal cord injury, characterized by predominant upper extremity weakness, and less severe sensory and bladder dysfunction. ATCCS is thought to result from post-traumatic centro-medullary hemorrhage and edema, or, as more recently proposed, from a Wallerian degeneration, as a consequence of spinal cord pinching in a narrowed canal. Magnetic Resonance Imaging is the method of choice for diagnosis, showing a typical intramedullary hypersignal on T2 sequences. Non-surgical treatment relies on external cervical immobilization, maintenance of a sufficient systolic blood pressure, and early rehabilitation, and should be reserved for patients suffering from mild ATCCS. Surgical management of ATCCS consists of posterior, anterior or combined approaches, in order to achieve spinal cord decompression, with or without stabilization. The benefits of early surgical decompression in the setting of ATCCS remain controversial due to the lack of clinical randomized trials; recent studies suggest that early surgery (less than 72hours after trauma) appears to be safe and effective, especially for patients with evidence of focal anatomical cord compression.

Near-Miss Discharge of an Older Adult Male With Central Cord Syndrome

“…Acute traumatic central cord syndrome is reported to occur in between 11,000 and 12,000 individuals annually and represents more than 65% of the incomplete spinal cord injuries (Harrop, Sharan, & Ratliff, 2006;Molliqaj, Payer, Schaller, & Tessitore, 2014). The spectrum of clinical presentation findings range from mild paresthesias and motor weaknesses, predominantly in upper to lower extremities, to bladder function disruption, to burning sensation, to full quadriparesis (Dahdaleh et al, 2013).…”

“…Acute traumatic central cord syndrome can be a disabling condition, and unfavorable outcomes appear to be age dependent (Harrop et al, 2006), although one research team suggests that there are also regional variations to morbidity and mortality (Brodell, Jain, Elfar, & Mesfin, 2015). Magnetic resonance imaging is the examination of choice (Molliqaj et al, 2014), given higher sensitivity and specificity than conventional radiographs (Harrop et al, 2006). Acute traumatic central cord syndrome has as its mechanism of injury a hyperextension event, followed by compression of the spinal column.…”

“…In the final impression, there is mention of the increased signal within the cord parenchyma. Increased signals, or hypersignals, make it possible to assess the extent of pathological process and reflect the presence of hemorrhage or edema (Harrop et al, 2006;Molliqaj et al, 2014). The radiologist's report also indicates that the cervical regions are affected.…”

Traumatic central cord syndrome after blunt cervical trauma: a pediatric case report

“…10 Cervical dynamic X-rays have an important role in the radiographic assessment of the eventually associated discoligamentous instability. 11 Significant radiographic pathologic views may or may not accompany the injury in plain radiographs. The absence of radiographic evidence is more frequent in children younger than 8 years and in those with high injury severity scores.…”

Early MRI finding in adult spinal cord injury without radiologic abnormalities does not correlate with the neurological outcome: a retrospective study

“…1 Most of the patients with ATCSCI are associated with spinal canal narrowing, [2][3][4] and they often present with cord hemorrhage, soft tissue and ligamentous injury, hematoma and herniated disk. The most important in the clinical practice is to exclude abnormalities of the cervical spine in trauma patients, as initiation of treatment within 24 h of injury can significantly improve neurologic outcome.…”