Reviews: Review Article

Acute Traumatic Myelopathy: Rethinking Central Cord Syndrome

Bulloch, Landon R. MD; Spector, Leo MD, MBA; Patel, Alpesh MD, MBA

From the Atrium Health Musculoskeletal Institute, Charlotte NC (Bulloch), the OrthoCarolina Spine Center, OrthoCarolina Research Institute, Charlotte, NC (Spector), and the Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago IL (Patel).

Spector or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of NuVasive and Stryker; serves as a paid consultant to NuVasive and Stryker; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from NuVasive and Synthes; and serves as a board member, owner, officer, or committee member of the Cervical Spine Research Society and the Spine Research Society. Patel or an immediate family member has received royalties from NuVasive, Zimmer Biomet, Amedica, and Alphatec Spine; serves as a paid consultant to Zimmer Biomet, DePuy Synthes, nView, Amedica, Kuros Biosciences, and AIM; has stock or stock options held in Nocimed, Cytonics, nView, Tissue Differentiation Intelligence, and Endoluxe; has received Fellowship Program Support from NuVasive and AO Spine North America; serves as a board member, owner, officer, or committee member of the Cervical Spine Research Society and Editorial Board Contemporary Spine Surgery Journal of American Academy of Orthopaedic Surgery (Deputy Editor). Neither Dr. Bulloch nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

Journal of the American Academy of Orthopaedic Surgeons 30(23):p 1099-1107, December 1, 2022. | DOI: 10.5435/JAAOS-D-22-00260

Abstract

Central cord syndrome (CCS) is an incomplete spinal cord injury that consists of both sensory and motor changes of the upper and lower extremities. CCS most commonly occurs after trauma to the cervical spine leading to acute neurological changes. Despite being the most common incomplete spinal cord injury with the best outcomes, optimal treatment remains controversial. Although clinical practice has shifted from primarily conservative management to early surgical intervention, many questions remain unanswered and treatment remains varied. One of the most limiting aspects of CCS remains the diagnosis itself. CCS, by definition, is a syndrome with a very specific pattern of neurological deficits. In practice and in the literature, CCS has been used to describe a spectrum of neurological conditions and traumatic morphologies. Establishing clarity will allow for more accurate decision making by clinicians involved in the care of these injuries. The authors emphasize that a more precise term for the clinical condition in question is acute traumatic myelopathy: an acute cervical cord injury in the setting of a stable spine with either congenital and/or degenerative stenosis.