Central Spinal Cord Syndrome

KEY FACTS

Terminology

• Central cord syndrome (CCS), acute traumatic central cord syndrome (ATCCS)

• Most common partial cord syndrome

• Traumatic cord injury, with clinical syndrome of

  • Bilateral weakness, arms > legs

  • Bladder dysfunction, variable sensory loss

• Injury to central gray matter, corticospinal and spinothalamic tracts

Imaging

• Radiographs may show spondylosis or congenitally diminished canal diameter

• MR shows hyperintense signal in central spinal cord on T2WI

• Significant percentage shows fracture/dislocations

Pathology

• Often with preexisting canal stenosis

  • Congenital canal stenosis

  • Disc herniation, osteophyte

  • Facet/ligamentous hypertrophy

Clinical Issues

• 4 groups

  • 10% of ATCCS patients have MR evidence of cord signal change with no other radiographic abnormality

    • –

      Medical management

  • 20% of ATCCS patients present with acute disc herniation

    • –

      Surgical intervention recommended

  • 30% of ATCCS patients have cervical spine fracture subluxation injuries

    • –

      Early realignment of spinal column with spinal cord decompression is recommended

  • 40% of ATCCS patients have spinal stenosis without evidence of bony or ligamentous injury

    • –

      Management remains controversial

TERMINOLOGY

IMAGING