Central Cord Syndrome: Symptoms, Causes, and Diagnosis

Central cord syndrome (CCS) is one of the most common types of incomplete spinal cord injuries, typically occurring after severe trauma to the cervical spine. It frequently results from hyperextension injuries—often seen in car accidents, falls, or sports-related impacts—where the neck is abruptly forced backward. This sudden movement can compress or damage the central portion of the spinal cord, particularly in individuals with pre-existing cervical spinal stenosis. The resulting neurological deficits are distinctive and primarily affect the upper extremities more than the lower limbs.

Primary Clinical Features of Central Cord Syndrome

Upper Limb Dysfunction Dominates: One of the hallmark signs of CCS is disproportionate motor and sensory impairment in the arms and hands compared to the legs. Patients often report numbness, tingling, or hypersensitivity in the neck, shoulders, and both upper limbs. Weakness in the hands and arms can range from mild clumsiness to significant loss of fine motor control, making everyday tasks like buttoning a shirt or holding objects difficult.

In many cases, there is a phenomenon known as sensory dissociation, where patients may lose the ability to perceive pain and temperature while preserving touch and proprioception. This occurs due to the specific anatomical arrangement of nerve fibers within the spinal cord—particularly the crossing spinothalamic tracts that transmit pain and temperature signals.

Milder Lower Extremity Involvement

While leg function is usually less severely affected, patients may still experience mild weakness, stiffness, or difficulty with coordination when walking. The degree of lower limb impairment varies, but it's typically less pronounced than the upper body symptoms. In some cases, individuals may feel unsteady on their feet or require assistance for balance.

Potential Complications and Autonomic Dysfunction

In more severe instances of central cord syndrome, patients may develop issues related to autonomic nervous system control. This includes bladder and bowel dysfunction, such as urinary retention, incontinence, or constipation. These symptoms indicate a more extensive spinal cord involvement and require prompt medical evaluation and management to prevent complications like urinary tract infections or bowel impaction.

Diagnostic Imaging and Evaluation

To confirm a diagnosis of central cord syndrome, healthcare providers rely heavily on advanced imaging techniques. Cervical X-rays are often the first step, helping identify fractures or misalignments in the spine. However, more detailed assessments require computed tomography (CT) scans and especially magnetic resonance imaging (MRI), which provide clear visualization of soft tissue damage, spinal cord swelling, hemorrhage, or compression from herniated discs or bone spurs.

Early and accurate diagnosis is crucial for determining the appropriate treatment plan, which may include surgical intervention, physical therapy, and long-term rehabilitation strategies aimed at maximizing functional recovery.