Central Cord Syndrome – Diagnosis and Early Management

Clinical Presentation

Upper‑extremity motor weakness is markedly greater than lower‑extremity weakness, constituting the hallmark feature of central cord syndrome (e.g., 2/5 vs 3/5 strength)【1】【2】【3】.
Bladder dysfunction, most commonly urinary incontinence or retention, frequently accompanies the motor pattern in central cord syndrome【1】【2】.

Central cord syndrome is now the most common acute traumatic spinal cord injury in older adults; it typically follows low‑energy mechanisms such as falls in patients around 70 years of age【1】【2】【3】.

The injury involves the central portion of the cervical spinal cord, usually produced by a hyperextension force acting on a spine with pre‑existing cervical stenosis (degenerative or congenital)【1】【2】.

An urgent magnetic resonance imaging (MRI) study is essential to detect spinal cord compression, epidural hematoma, disc herniation, or ligamentous injury that may require operative treatment【4】.
MRI provides superior sensitivity compared with computed tomography (CT) for identifying these pathologies and therefore better guides surgical decision‑making【4】.

Early surgical decompression (≤ 24 h after injury) should be strongly considered when ongoing cord compression is identified, as it is associated with significantly better neurological recovery at 6 months versus delayed surgery【3】【4】.
The STASCIS (Surgical Timing in Acute Cervical Spinal cord injury) prospective cohort study demonstrated that early surgery leads to improved functional outcomes in cervical spinal cord injuries, providing moderate‑quality evidence for early intervention【3】.