MRI-pathological correlations in acute traumatic central cord syndrome: case report

Abstract

Ante- and post-mortem MRI and detailed pathological examination were performed in a patient with a typical acute traumatic central cord syndrome (ATCCS) after a minor hyperextension injury to the neck who died 60 h later from heart failure. T2-weighted MRI showed a central hyperintense area at C3-4. There were disc protrusions, but no vertebral fracture or displacement. Histopathology disclosed severe axonal swelling and oedema in the dorsolateral fasciculi and, to a lesser degree, in the dorsal columns. In addition, an area of recent necrosis was found in the right anterior horn at C4-5. These findings suggest that the pathological hallmark of typical ATCCS is mechanical axonal disruption at a segmental level, but that more severe trauma may be accompanied by tissue destruction.

Diagnostic criteria of traumatic central cord syndrome. Part 2: A Questionnaire Survey among Spine Specialists

“…In the recent past, the historical report of Schneider et al 1 has been challenged. Not only have the original descriptions of pathogenesis and neuroanatomical basis of TCCS been criticized, [7][8][9][10][11] but optimal treatment of the condition has also been reappraised. 3,[12][13][14][15][16] This survey study challenges the ambiguity of the TCCS definition as introduced by Schneider et al Whereas several physicians assign a diagnosis of TCCS in SCI patients with only 1 motor score point lower in the upper extremities than in the lower extremities, other physicians consider patients with a minimum difference of 15 points as TCCS patients.…”

Retropulsion of intervertebral discs associated with traumatic hyperextension of the cervical spine and absence of vertebral fracture: an uncommon mechanism of spinal cord injury

“…Examination of the vertebral column identi®ed severe disc injuries at C 3-4 , C 4-5 , and C [5][6] , with ruptures of the anterior longitudinal ligament at each level and partial avulsion of each disc from the anterior part of each vertebral end-plate and bleeding into the discs. There was also posterior herniation of the C 3-4 disc against the anterior cord.…”

“…The facet joints at these levels showed hemarthroses. The left C 5-6 facet joint showed traumatic detachment of its articular cartilage on both facets and localized damage to the tip of the superior articular process of C 6 . Smaller traumatic disc lesions (anterior rim lesions) were present at C 2-3 on the left side.…”

“…The most commonly invoked explanations for these injuries include impingement of the cord by the anterior bulging of the ligamentum¯avum, 4,6,8 encroachment into a narrowed spinal canal by midline osteophytes, 5,9 a`pincer' mechanism involving anterior translation of the vertebra or posterior translation with the posterior-inferior edge of the vertebral body compressing the cord against the superior edge of the subadjacent lamina, 4,5,9,10 cord traction 2 or tensile forces within the cord. 8 These eects may be additive.…”

“…9 The present report describes a relatively uncommon mechanism of traumatic cervical cord injury following hyperextension without vertebral fracture or residual dislocation. The primary pathology involves multiple sites of failure of the anterior longitudinal ligament, posterior disc protrusion at C 3-4 , C 4-5 , C [5][6] , disc herniation at C 3-4 with extradural cord compression, and focal cord hemorrhage at three distinct locations.…”