Central Cord Compression 11

8/3/2019 Central Cord Compression 11

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Central Cord Compression



What is it?

It is an acute cervical spinal cord injury affecting thecentral spinal cord or grey matter

It is an incomplete spinal cord injury where there is

greater weakness or outright paralysis of the upperextremities, as compared with the lower extremities.

This is due to the fact that the outer (peripheral) areasof the cervical spinal cord are spared, informationgoing to and from the brain and the lower extremitiesis not as severely affected.

It is also commonly known as Central Cord Syndrome(C.C.S).



Pathology

Typically occurs in older patients with long

standing cervical spondylosis as this reduces

the space in spinal canal and increases risk of

pressure on the cord due to varying factors.

Unlike a complete lesion, that causes loss of

all sensation and movement below the level of

the injury, an incomplete lesion causes only a

partial loss of sensation and movement.



This syndrome is associated with damage tothe large nerve fibres that carry information

directly from the cerebral cortex to the spinalcord and control hand and arm function.

The overall amount and type of functional lossis dependent upon the severity of nervedamage.

It is generally associated with hyperextensioninjury in older pts hence the spinal cord is

pinched by the ligamentum flavum(posteriorly) or compression by osteophytes(anteriorly).





Causes

Trauma most commonly resulting fromfalls

Cervical Spondylosis (particularly in olderadults)

In younger individuals, Central CordCompression results from major trauma,

e.g., Cervical Fractures/Subluxations Bleeding into the central part of the cord



Incidence

In 2007 it was estimated that the annualincidence of Spinal Cord Injury (SCI) wasapproximately 40 per million in the UnitedStates, with over 11 000 new cases each year.

Central Cord Compression is considered tobe the most common SCI, accounting for 9% of

all traumatic SCIs. Affects more men than women with a ratioof 3:1



Signs and Symptoms

Numbness, weakness or difficulty using your arms or legs

Impairment in the upper extremities is usually greater than in the

lower extremities and is especially prevalent in the muscles of thehand.

Sensory loss is variable, although sacral sensation is usually present.

Anal wink, anal sphincter tone, and Babinski reflexes should be tested.

Muscle stretch reflexes may initially be absent but will eventually

return along with variable degrees of spasticity in affected muscles.



Pain or tenderness in the middle or top of your back

or neck

Severe pain in your lower back that gets worse or

doesnt go away

Pain in your back that is worse when you cough,

sneeze or go to the toilet

Bladder or bowel difficulties



Signs on Subjective Assessment

MAIN PROBLEM

- Numbness and tingling in arms and hands

- Sensory loss

24 HOUR PATTERN

- Problems with ADL esp. lifting and carrying things as reduced sensationin arms

- Problems with fine motor control in hands e.g. buttoning shirts

- problems withwalking as muscle weakness in legs

HPC / PMH- trauma esp. In a younger person causing a hyperextension injury

- fall in an older person with a history of spondylosis

MANDATORYQUESTIONS

- will have bladder dysfunction



Signs on Objective Assessment

May present with one sidedweakness or weakness inthe upper extremitiesgreater than in the lowerextremities noticeable onobservation

Injury noticeable onneurological tests

- muscle power reduced esp.in arms

- sensory loss below site of injury

- reflexes absent below siteof injury



Prognosis

The patient who receive early treatment, are the oneswho usually recover better.

Walking will improve over time, however patients areusually left with some disability.

Improvement usually starts in the lower limbs, movingnext to the bladder and lastly the upper limbs will start toshow improvement.

A recent study by Lenehana et al. researched the clinicaloutcomes of 50patients with central cord compression. It

showed that patients over the age of 70 tended to have asignificantly poorer clinical outcome than youngerpatients with the same condition.



Rx.

There is no real cure for central cord compression, nor is therea standard course of treatment, although drug therapy,surgery, physiotherapy treatment and rest are often part of the program.

Magnetic resonance imaging (MRI) is often used to indicatethe degree of spinal cord compression and vertebralinstability. Recent studies suggest that surgery can bebeneficial in individuals with persistent compression of thespinal cord and ongoing neurological deterioration. However

the need for surgical treatment has to be individualised. If you become aware of signs of central cord compression

refer on for orthopaedic/neurology appointment, if caudasigns then treat as an emergency



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Central Cord Compression 11