Abstract
Background:The classical clinical presentation, neuroradiographic features, and conservative vs. surgical management of traumatic cervical central spinal cord (CSS) injury remain controversial.Methods:CSS injuries, occurring in approximately 9.2% of all cord injuries, are usually attributed to significant hyperextension trauma combined with congenital/acquired cervical stenosis/spondylosis. Patients typically present with greater motor deficits in the upper vs. lower extremities accompanied by patchy sensory loss. T2-weighted magnetic resonance (MR) scans usually show hyperintense T2 intramedullary signals reflecting acute edema along with ligamentous injury, while noncontrast computed tomography (CT) studies typically show no attendant bony pathology (e.g. no fracture, dislocation).Results:CSS constitute only a small percentage of all traumatic spinal cord injuries. Aarabi et al. found CSS patients averaged 58.3 years of age, 83% were male and 52.4% involved accidents/falls in patients with narrowed spinal canals (average 5.6 mm); their average American Spinal Injury Association (ASIA) motor score was 63.8, and most pathology was at the C3-C4 and C4-C5 levels (71%). Surgery was performed within 24 h (9 patients), 24–48 h (10 patients), or after 48 h (23 patients). In the Brodell et al. study of 16,134 patients with CSS, 39.7% had surgery. In the Gu et al. series, those with CSS and stenosis/ossification of the posterior longitudinal ligament (OPLL) exhibited better outcomes following laminoplasty.Conclusions:Recognizing the unique features of CSS is critical, as the clinical, neuroradiological, and management strategies (e.g. conservative vs. surgical management: early vs. late) differ from those utilized for other spinal cord trauma. Increased T2-weighted MR images best document CSS, while CT studies confirm the absence of fracture/dislocation.
Highlights
Traumatic cervical central cord spinal injuries (CSS) are more readily recognized both clinically and on magnetic resonance (MR) scans
McKinley found that 9.2% of all spinal cord injuries were attributed to central spinal cord syndromes (CSSs; 77 of 839).[21]
When presenting to emergency rooms, typically with greater upper vs. lower extremity neurological deficits, CSS patients first undergo computed tomography (CT) studies to rule out fracture/ dislocation, and secondarily have MR examinations looking for classical central cord contusion/edema/ hematomas, along with other factors [Table 1]
Summary
Traumatic cervical central cord spinal injuries (CSS) are more readily recognized both clinically and on magnetic resonance (MR) scans. McKinley found that 9.2% of all spinal cord injuries were attributed to central spinal cord syndromes (CSSs; 77 of 839).[21] When presenting to emergency rooms, typically with greater upper vs lower extremity neurological deficits, CSS patients first undergo computed tomography (CT) studies to rule out fracture/ dislocation, and secondarily have MR examinations looking for classical central cord contusion/edema/ hematomas, along with other factors (e.g. ligamentous injury, disc herniations) [Table 1]. The management of these injuries with or without surgery remains controversial [Table 1]. The classical clinical presentation, neuroradiographic features, and conservative vs. surgical management of traumatic cervical central spinal cord (CSS) injury remain controversial
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