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Central Cord Syndrome (CCS)


Central cord syndrome (CCS) is an incomplete traumatic injury to the cervical spinal cord. The portion of the spinal cord that goes through the neck bones. This injury leads to a weakening of the arms rather than the legs. This is called an incomplete injury because the patient is not totally paralyzed.


Central cord syndrome can happen in people with existing arthritis changes in the neck bones. The spinal cord canal can be narrow in these situations. When the neck is extended in a traumatic accident, the spinal cord may be compressed. This usually results in no obvious breakage of the neck and the spine could be stable. When the spinal cord is squeezed, this can lead to swelling, bleeding, or bruising. This will happen near the central position of the spinal cord. The arms are more affected than the legs in a spinal cord injury because the spinal cord relates to the movement of the arms. Patients with central cord syndrome sometimes cannot regain strength of their arms or hands but often will walk and use their legs normally.



Symptoms include a weakness in the arms and upper extremities. There is usually not much weakness in the lower extremities or legs. This can lead to difficulty doing daily, simple tasks, like writing, walking, doing buttons, etc. Another symptom is trouble with urination. Neck pain is also a common symptom but depends on the accident that has occured.

This syndrome happens the most in patients over the age of 50, who have gone through a neck hyperextension injury. Central cord syndrome usually occurs in male over females. This can be seen in athletes who have had hyperextension injuries to their neck, ruptured discs, or have had a compressed spinal cord.   



After an accident or an injury, if the symptoms above begin to appear, seek medical care immediately. The medical provider will assess the patient. The patient may need to see a spine specialist or a neurosurgeon. 



A complete medical history, neurological examinations, cervical magnetic resonance imaging, computed tomography (CT) scan and plain cervical spine X-rays, including supervised flexion and extension views will be needed in an evaluation of the patient.


Evaluation of a patient with suspected CCS includes a complete medical history, thorough general and neurological examinations, cervical magnetic resonance imaging (MRI), computed tomography (CT) scan and plain cervical spine X-rays, including supervised flexion and extension views.


Nonsurgical treatment

Non-surgical management of CCS should be the first option. This includes immobilization of the neck with a cervical collar, rehabilitation, and physical therapy. 


Unless there is significant compression to the spinal cord, surgery is not usually needed. The compressed spinal cord can be quickly diagnosed and surgically decompressed due to advanced technology. Surgery is typically not done until a significant recovery has been made in patients where bony arthritis changes lead to the narrowing of the spinal canal. Surgery can be done if there is a treatable lesion with motor weakness after a time of recovery or if there is neurological deterioration. More scans may be needed before surgery.


Many of the CCS patients make a spontaneous recovery of motor function but others may see recovery over a sex week time period post injury.

If the main problem is the swelling in the spinal cord, recovery can be soon after first symptoms appear. Usually function of the legs return first, then bladder control, then arm function. Hand and finger movement will come back last. If the problem happens because of bleeding or a stroke in the spinal cord, then recovery does not have as high chances.

Younger patients usually have a faster recovery than older patients. Many young patients can live a normal life again.


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