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Central Cord Syndrome

Dr. Nowak is Orthopaedic Surgery Resident, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY. Dr. Lee is Orthopaedic Surgery Resident, New York-Presbyterian Hospital, Columbia University Medical Center. Dr. Gelb is Associate Professor of Orthopaedics, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD. Dr. Poelstra is Assistant Professor of Orthopaedics, Department of Orthopaedics, University of Maryland Medical Center. Dr. Ludwig is Associate Professor and Chief of Spine Surgery, Department of Orthopaedics, University of Maryland Medical Center.

Dr. Gelb or a member of his immediate family serves as a board member, owner, officer, or committee member of AO Spine North American Education committee; has received royalties from Globus Medical; is a member of a speakers’ bureau or has made paid presentations on behalf of Synthes; serves as a paid consultant to or is an employee of Alphatec Spine and Synthes; has received research or institutional support from Synthes; and has stock or stock options held in Alphatec Spine. Dr. Poelstra or a member of his immediate family is a member of a speakers’ bureau or has made paid presentations on behalf of and serves as a paid consultant to or is an employee of DePuy. Dr. Ludwig or a member of his immediate family has received royalties from DePuy and Globus Medical; is a member of speakers’ bureau or has made paid presentation on behalf of AO, DePuy, Globus Medical, Stryker, and Synthes; serves as a paid consultant to or is an employee of AO, DePuy, Globus Medical, Stryker, and Synthes; has received research or institutional support from Synthes; has stock or stock options held in Globus Medical; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from AO, DePuy, Globus Medical, Stryker, and Synthes. Neither of the following authors nor a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Nowak and Dr. Lee.

Reprint requests: Dr. Ludwig, Department of Orthopaedics, University of Maryland Medical Center, Suite S11B, 22 South Greene Street, Baltimore, MD 21201.

Central cord syndrome is the most common type of incomplete spinal cord injury. This syndrome most often occurs in older persons with underlying cervical spondylosis caused by a hyperextension mechanism. It also occurs in younger persons who sustain trauma to the cervical spine and, less commonly, as a result of nontraumatic causes. The upper extremities are more affected than the lower extremities, with motor function more severely impaired than sensory function. Central cord syndrome presents a spectrum, from weakness limited to the hands and forearms with sensory preservation, to compete quadriparesis with sacral sparing as the only evidence of incomplete spinal cord injury. Historically, treatment has been nonsurgical, but recovery is often incomplete. Early surgical treatment of central cord syndrome remains controversial. However, recent studies have shown benefits, particularly of early surgery to decompress the spinal cord in patients with pathologic conditions revealed by radiography or MRI.