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Current Concepts

Central Cord Syndrome

Hashmi, Sohaib Z., MD*; Marra, Angelo, BS*; Jenis, Louis G., MD; Patel, Alpesh A., MD*

doi: 10.1097/BSD.0000000000000731

Central cord syndrome (CCS) represents a clinical phenomenon characterized by disproportionately greater motor impairment of the upper than of the lower extremities, bladder dysfunction. CSS is the most common form of incomplete traumatic spinal cord injury. The initial description of CSS was reported in 1887 secondary to cervical spinal trauma. However, recent literature describes a heterogenous injury patterns including high-energy and low-energy mechanisms and bimodal patient age distributions. Pathophysiology of clinical symptoms and neurological deficits often is affected by preexisting cervical spondylosis. Urgent clinical diagnosis is dependent on neurological examination and imaging studies. Treatment of CSS is dependent on injury mechanism and compressive lesions, neurological examination, preexisting cervical pathology, and patient-specific comorbidities. This article will review the current concepts in diagnosis, pathophysiology, and treatment of CSS with a highlighted case example.

*Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL

Partners Healthcare, NWH-Spine Center, Newton, MA

A.A.P. is a Consultant at: Amedica, Biomet, DePuy, Stryker spine, Relievant, Pacira. Received Product Design/Royalties from: Amedica, Ulrich medical, Biomet. Holds stock options/ownership (<1%) at: Amedica, Vital5, Nocimed, Cytonics. Editorial Board at: Contemporary Spine Surgery, Surgical Neurology International, Journal of American Academy of Orthopaedic Surgery. L.G.J. is a Consultant at: Stryker spine, Instrinsic spine, Vallum, MicroMedicine. Scientific Board at: Surgivisio. Received royalties from Stryker spine. The remaining authors declare no conflict of interest.

Reprints: Sohaib Z. Hashmi, MD, Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair, Suite 1350, Chicago, IL 60611 (e-mail:

Received September 18, 2018

Accepted September 20, 2018

© 2018 by Lippincott Williams & Wilkins, Inc.