Spinal cord injuries affect the body in various ways. These types of injury are classified according to the level on which the damage occurs and whether it is considered complete or incomplete.
Complete spinal injuries mean the cord is severed and there is generally no movement or sensation below the level of the damaged area. The prognosis for full recovery here is extremely poor.
Incomplete spinal cord injuries mean there is only partial damage and there are varying degrees of movement and sensation. For example, an individual may have partial movement in their legs and be able to walk with an assistive device.
One specific type of incomplete spinal cord injury is called central cord syndrome.
Central cord syndrome affects the cervical region of the spinal cord around the neck. It is an incomplete spinal injury and affected individuals are not fully paralyzed i.e. they will have some degree of movement in their arms and legs. Symptoms will vary in severity depending on the extent of the injury.
Central cord syndrome generally affects the arms and hands more than the legs. That’s because the large nerves which serve these areas of the body are damaged or impaired in some way. This could be because of the compression of the spine or narrowing due to bony growths.
There is usually no sign of a break or damage to the bone of the vertebrae, as seen in other, traumatic types of spinal cord injury. However, the spinal cord may be bruised, there could be bleeding or other trauma that indicates central cord syndrome.
Central cord syndrome accounts for almost 10% of SCIs and is the most common type of incomplete spinal cord injury. In older patients, it often occurs as a result of an underlying condition such as cervical spondylosis or arthritis.
Hyperextension, where the cord gets caught between the vertebral discs, could also cause acute damage, though in many cases the injury is chronic and occurs over a period of time. In some cases, bony growths narrow the spinal canal and cause compression symptoms, including weakness in the arms and hands.
In younger patients, the most obvious cause of central cord syndrome is trauma. This can happen, for example, when the neck is pushed forcefully back following an automobile accident. These types of injuries can also happen following a sporting injury, particularly with contact sports such as American Football.
While central cord syndrome can affect mobility in both arms and legs, it usually impacts the arms and hands more. Patients will generally notice some form of weakness in the upper limbs, particularly in relation to fine motor movement.
For example, the affected individual may have difficulty holding a pen or doing up buttons on their clothes. They may also experience neck pain, if the injury is severe enough.
Other symptoms include a lack of sensation when urinating as well as weakness in the legs, though patients can normally walk. In the case of an acute injury, these symptoms will come on fairly quickly. With chronic conditions, they may take time to develop.
Diagnosis of central cord syndrome usually involves noting the specific symptoms which can be confirmed with tests such as an MRI, X-ray and CAT scan.
There is no standard procedure for treating central cord syndrome and there is no definitive cure. Many patients will recover in time with rest and suitable physiotherapy, others will need to manage the condition throughout their lifetime.
The use of medication, physiotherapy, rest and surgery are options. Surgery is generally suggested when there is instability in the vertebrae that is likely to worsen the condition or there is persistent compression. There is some evidence to suggest that early surgical intervention can improve the prognosis for the condition.
Patients will be monitored closely in the first instance to see if their condition improves over time. They will often work directly with a physiotherapist and occupational therapist to set goals and improve, or at least maintain, mobility.
The prognosis will depend on the extent of the injury and the individual. Many patients see improvements in their condition over time, though not all will experience a complete recovery. If they suffer from impairment in the lower limbs and find it difficult to walk, in most cases, these specific symptoms will be alleviated over time.
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