Skip to main content

Advertisement

SpringerLink
Log in

Hyperextension injury of the cervical spine with central cord syndrome

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Traumatic central cord syndrome (TCCS) is the most commonly encountered type of incomplete spinal cord injury. TCCS typically occurs in patients over the age of 50 with a narrow spinal canal and follows an acute hyperextension injury of the cervical spine. Here, we report on the demographics of TCCS patients, their clinical course and outcomes, and the factors that may have influenced these outcomes.

Methods

We conducted a retrospective folder review of patients who presented to our facility between January 2004 and December 2008 following hyperextension injury of the cervical spine and with the clinical manifestations of a central cord syndrome. Patient details were obtained from the acute spinal cord injury register at Groote Schuur Hospital and the patient folders, radiographs and magnetic resonance imaging films were reviewed. Predetermined data points were identified, tabulated and analysed, with only information from the injury-related admission being included.

Results

An ASIA motor score of ≥60 on admission or discharge correlated with an 80 % chance of being able to walk at discharge from hospital. An ASIA motor score of ≤50 on admission correlated with an 80 % chance of not walking at discharge. An ASIA motor score of ≤50 at discharge meant a patient was not only unable to walk, but required placement in a spinal injury rehabilitation centre. Further, if a patient had a cervical spinal canal diameter of ≥8 mm they had a 50 % chance of clinical improvement and nearly 80 % chance of a functional outcome.

Conclusion

The Groote Schuur Hospital patient population differs from the international norm, particularly with respect to age and mechanism of injury. The ASIA motor score and cervical spine canal diameter proved to be useful predictors of outcome. Within our patient group, timing of surgery did not appear to influence the outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Greenberg MS (2010) Handbook of neurosurgery, 7th edn. Greenberg Graphics, Thieme Medical Publishers, Tampa, New York

    Google Scholar 

  2. McKinley W, Santos K, Meade M, Brooke K (2007) Incidence and outcomes of spinal cord injury clinical syndromes. J Spinal Cord Med 30(3):215–224

    PubMed Central  PubMed  Google Scholar 

  3. Bosch A, Stauffer ES, Nickel VL (1971) Incomplete traumatic quadriplegia. A 10-year review. JAMA J Am Med Assoc 216(3):473–478

    Article  CAS  Google Scholar 

  4. Merriam WF, Taylor TK, Ruff SJ, McPhail MJ (1986) A reappraisal of acute traumatic central cord syndrome. J Bone Jt Surg Br 68(5):708–713

    CAS  Google Scholar 

  5. Thorburn W (1887) Cases of injury to the cervical region of the spinal cord. Brain 9(4):510–543

    Article  Google Scholar 

  6. Schneider RC, Thompson JM, Bebin J (1958) The syndrome of acute central cervical spinal cord injury. J Neurol Neurosurg Psychiatry 21(3):216–227

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Taylor AR (1951) The mechanism of injury to the spinal cord in the neck without damage to vertebral column. J Bone Jt Surg Br 33-B(4):543–547

    CAS  Google Scholar 

  8. Nathan PW, Smith MC, Deacon P (1990) The corticospinal tracts in man. Course and location of fibres at different segmental levels. Brain 113(Pt 2):303–324

    Article  PubMed  Google Scholar 

  9. Quencer RM, Bunge RP, Egnor M, Green BA, Puckett W, Naidich TP, Post MJ, Norenberg M (1992) Acute traumatic central cord syndrome: MRI-pathological correlations. Neuroradiology 34(2):85–94

    Article  CAS  PubMed  Google Scholar 

  10. Yamazaki T, Yanaka K, Fujita K, Kamezaki T, Uemura K, Nose T (2005) Traumatic central cord syndrome: analysis of factors affecting the outcome. Surg Neurol 63(2):95–99. doi:10.1016/j.surneu.2004.03.020 discussion 99–100

    Article  PubMed  Google Scholar 

  11. Fehlings MG, Vaccaro A, Wilson JR, Singh A, WCadotte D, Harrop JS, Aarabi B, Shaffrey C, Dvorak M, Fisher C, Arnold P, Massicotte EM, Lewis S, Rampersaud R (2012) Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One 7(2):e32037

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Wilson JR, Fehlings MG (2011) Emerging approaches to the surgical management of acute traumatic spinal cord injury. Neurother J Am Soc Exp Neurother 8(2):187–194. doi:10.1007/s13311-011-0027-3

    Article  Google Scholar 

  13. Furlan JC, Noonan V, Cadotte DW, Fehlings MG (2011) Timing of decompressive surgery of spinal cord after traumatic spinal cord injury: an evidence-based examination of pre-clinical and clinical studies. J Neurotrauma 28(8):1371–1399. doi:10.1089/neu.2009.1147

    Article  PubMed Central  PubMed  Google Scholar 

  14. Cadotte DW, Fehlings MG (2011) Spinal cord injury: a systematic review of current treatment options. Clin Orthop Relat Res 469(3):732–741. doi:10.1007/s11999-010-1674-0

    Article  PubMed Central  PubMed  Google Scholar 

  15. Stevens EA, Marsh R, Wilson JA, Sweasey TA, Branch CL Jr, Powers AK (2010) A review of surgical intervention in the setting of traumatic central cord syndrome. Spine J Off J N Am Spine Soc 10(10):874–880. doi:10.1016/j.spinee.2010.07.388

    Article  Google Scholar 

  16. Aito S, D’Andrea M, Werhagen L, Farsetti L, Cappelli S, Bandini B, Di Donna V (2007) Neurological and functional outcome in traumatic central cord syndrome. Spinal Cord 45(4):292–297. doi:10.1038/sj.sc.3101944

    CAS  PubMed  Google Scholar 

  17. Dvorak MF, Fisher CG, Hoekema J, Boyd M, Noonan V, Wing PC, Kwon BK (2005) Factors predicting motor recovery and functional outcome after traumatic central cord syndrome: a long-term follow-up. Spine 30(20):2303–2311

    Article  PubMed  Google Scholar 

  18. Chen TY, Lee ST, Lui TN, Wong CW, Yeh YS, Tzaan WC, Hung SY (1997) Efficacy of surgical treatment in traumatic central cord syndrome. Surg Neurol 48(5):435–440 discussion 441

    Article  CAS  PubMed  Google Scholar 

  19. Guest J, Eleraky MA, Apostolides PJ, Dickman CA, Sonntag VK (2002) Traumatic central cord syndrome: results of surgical management. J Neurosurg 97(1 Suppl):25–32

    PubMed  Google Scholar 

  20. Uribe J, Green BA, Vanni S, Moza K, Guest JD, Levi AD (2005) Acute traumatic central cord syndrome—experience using surgical decompression with open-door expansile cervical laminoplasty. Surg Neurol 63(6):505–510. doi:10.1016/j.surneu.2004.09.037

    Article  PubMed  Google Scholar 

  21. Lenehan B, Street J, O’Toole P, Siddiqui A, Poynton A (2009) Central cord syndrome in Ireland: the effect of age on clinical outcome. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 18(10):1458–1463. doi:10.1007/s00586-009-1107-5

    Article  Google Scholar 

  22. Harrop JS, Sharan A, Ratliff J (2006) Central cord injury: pathophysiology, management, and outcomes. Spine J Off J N Am Spine Soc 6(6 Suppl):198S–206S. doi:10.1016/j.spinee.2006.04.006

    Article  Google Scholar 

  23. Song J, Mizuno J, Nakagawa H, Inoue T (2005) Surgery for acute subaxial traumatic central cord syndrome without fracture or dislocation. J Clin Neurosci Off J Neurosurg Soc Australas 12(4):438–443. doi:10.1016/j.jocn.2004.04.008

    Google Scholar 

  24. Aarabi B, Koltz M, Ibrahimi D (2008) Hyperextension cervical spine injuries and traumatic central cord syndrome. Neurosurg Focus 25(5):E9. doi:10.3171/FOC.2008.25.11.E9

    Article  PubMed  Google Scholar 

  25. Fong W, Eismont FJ (2007) Controversies in the treatment of central cord injuries. In: Seminars in Spine Surgery, vol 19. Elsevier, pp 260–271

  26. Chen L, Yang H, Yang T, Xu Y, Bao Z, Tang T (2009) Effectiveness of surgical treatment for traumatic central cord syndrome. J Neurosurg Spine 10(1):3–8. doi:10.3171/2008.9.SPI0822

    Article  PubMed  Google Scholar 

  27. Stevens EA, Powers AK, Branch CLJ (2009) The role of surgery in traumatic central cord syndrome. Neurosurg Q 19(4):222–227. doi:10.1097/WNQ.1090b1013e3181b1090cd1095a

    Article  Google Scholar 

  28. Lenehan B, Fisher CG, Vaccaro A, Fehlings M, Aarabi B, Dvorak MF (2010) The urgency of surgical decompression in acute central cord injuries with spondylosis and without instability. Spine 35(21 Suppl):S180–S186. doi:10.1097/BRS.0b013e3181f32a44

    Article  PubMed  Google Scholar 

  29. Raslan AM, Nemecek AN (2012) Controversies in the surgical management of spinal cord injuries. Neurol Res Int 2012:417834. doi:10.1155/2012/417834

    PubMed Central  PubMed  Google Scholar 

  30. Anderson DG, Sayadipour A, Limthongkul W, Martin ND, Vaccaro A, Harrop JS (2012) Traumatic central cord syndrome: neurologic recovery after surgical management. Am J Orthop 41(8):E104–E108

    PubMed  Google Scholar 

  31. Yadla S, Klimo P, Harrop JS (2010) Traumatic central cord syndrome: etiology, management, and outcomes. Top Spinal Cord Inj Rehabil 15(3):73–84

    Article  Google Scholar 

  32. Kim I (2011) Acute traumatic central cord syndrome: early decompression or not? Korean J Spine 8(1):45–51

    Google Scholar 

  33. Fehlings MG, Sekhon LH, Tator C (2001) The role and timing of decompression in acute spinal cord injury: what do we know? What should we do? Spine 26(24 Suppl):S101–S110

    Article  CAS  PubMed  Google Scholar 

  34. Fehlings MG, Perrin RG (2006) The timing of surgical intervention in the treatment of spinal cord injury: a systematic review of recent clinical evidence. Spine 31(11 Suppl):S28–S35. doi:10.1097/01.brs.0000217973.11402.7f discussion S36

    Article  PubMed  Google Scholar 

  35. Brodkey JS, Miller CF Jr, Harmody RM (1980) The syndrome of acute central cervical spinal cord injury revisited. Surg Neurol 14(4):251–257

    CAS  PubMed  Google Scholar 

  36. Chen TY, Dickman CA, Eleraky M, Sonntag VK (1998) The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis. Spine 23(22):2398–2403

    Article  CAS  PubMed  Google Scholar 

  37. Ditunno JF Jr (1992) Functional assessment measures in CNS trauma. J Neurotrauma 9(Suppl 1):S301–S305

    PubMed  Google Scholar 

  38. Ditunno JF Jr, Young W, Donovan WH, Creasey G (1994) The international standards booklet for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Paraplegia 32(2):70–80. doi:10.1038/sc.1994.13

    Article  PubMed  Google Scholar 

  39. Maynard FM Jr, Bracken MB, Creasey G, Ditunno JF Jr, Donovan WH, Ducker TB, Garber SL, Marino RJ, Stover SL, Tator CH, Waters RL, Wilberger JE, Young W (1997) International standards for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Spinal Cord 35(5):266–274

    Article  PubMed  Google Scholar 

  40. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, Johansen M, Jones L, Krassioukov A, Mulcahey MJ, Schmidt-Read M, Waring W (2011) International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med 34(6):535–546. doi:10.1179/204577211X13207446293695

    Article  PubMed Central  PubMed  Google Scholar 

  41. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia I. Paraplegia 7(3):179–192. doi:10.1038/sc.1969.30

    Article  CAS  PubMed  Google Scholar 

  42. Pouw MH, van Middendorp JJ, van Kampen A, Hirschfeld S, Veth RP, group E-Ss, Curt A, Hosman AJ, van de Meent H (2010) Diagnostic criteria of traumatic central cord syndrome. Part 1: a systematic review of clinical descriptors and scores. Spinal Cord 48(9):652–656. doi:10.1038/sc.2009.155

    Article  CAS  PubMed  Google Scholar 

  43. Schneider RC, Schemm GW (1961) Vertebral artery insufficiency in acute and chronic spinal trauma, with special reference to the syndrome of acute central cervical spinal cord injury. J Neurosurg 18:348–360. doi:10.3171/jns.1961.18.3.0348

    Article  CAS  PubMed  Google Scholar 

  44. Song J, Mizuno J, Inoue T, Nakagawa H (2006) Clinical evaluation of traumatic central cord syndrome: emphasis on clinical significance of prevertebral hyperintensity, cord compression, and intramedullary high-signal intensity on magnetic resonance imaging. Surg Neurol 65(2):117–123. doi:10.1016/j.surneu.2005.06.045

    Article  PubMed  Google Scholar 

  45. Malik SA, Murphy M, Connolly P, O’Byrne J (2008) Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 17(4):585–591. doi:10.1007/s00586-008-0603-3

    Article  CAS  Google Scholar 

  46. Fehlings MG, Perrin RG (2005) The role and timing of early decompression for cervical spinal cord injury: update with a review of recent clinical evidence. Injury 36(Suppl 2):B13–B26. doi:10.1016/j.injury.2005.06.011

    Article  PubMed  Google Scholar 

  47. Tow AM, Kong KH (1998) Central cord syndrome: functional outcome after rehabilitation. Spinal Cord 36(3):156–160

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neurosurgery, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, H53 Old Main Building, Main Road, Observatory, Cape Town, 7295, South Africa

    Crispin Thompson & David Welsh

  2. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia

    José Filipe Gonsalves

Authors
  1. Crispin Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. José Filipe Gonsalves
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Welsh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Crispin Thompson.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thompson, C., Gonsalves, J.F. & Welsh, D. Hyperextension injury of the cervical spine with central cord syndrome. Eur Spine J 24, 195–202 (2015). https://doi.org/10.1007/s00586-014-3432-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-014-3432-6

Keywords

Search

Navigation