1/11. Systemic lupus erythematosus: a unique cause of central cord syndrome, a case report. central cord syndrome has classically been defined by disproportionately more motor impairment of the upper than the lower extremities, bladder dysfunction, and varying degrees of sensory loss below the level of the lesion. review of the literature indicates that the majority of causes of central cord syndrome have a traumatic etiology and few are a consequence of connective tissue disorders. This is a case of a 53-year-old female with systemic lupus erythematosus who developed central cord syndrome due to an exacerbation of her disease. The patient presented with upper extremity motor and sensory deficits but only sensory deficits of the lower extremities. She had laboratory abnormalities consistent with lupus, and magnetic resonance imaging of the cervical spine revealed decreased attenuation from C-1-T-2. High-dose intravenous steroids were started in the acute care hospital with some return of proximal upper extremity strength. Upon transfer to the acute rehabilitation unit, the patient was noted to have neurogenic bladder dysfunction requiring a catheterization program. The patient was slowly tapered down on her oral prednisone with minimal improvement of strength but with return of bladder function. A review of the literature revealed few cases of central cord syndrome secondary to a connective tissue disorder or a non-traumatic etiology. ( info) |
2/11. A histopathological analysis of the human cervical spinal cord in patients with acute traumatic central cord syndrome. STUDY DESIGN: We have applied conventional histochemical and morphometric techniques to study the changes within the human spinal 'hand' motor neuron pool after spinal cord injury in patients who presented with acute traumatic central cord syndrome (ATCCS). OBJECTIVE: To determine whether a reduction of large alpha motor neurons at the C7, C8 and T1 spinal cord levels underlies the mechanism which causes hand dysfunction seen in patients with (ATCCS). BACKGROUND: The etiology of upper extremity weakness in ATCCS is debated and injury and/or degeneration of motor neurons within the central gray matter of the cervical enlargement has been advanced as one potential etiology of hand weakness. methods: The spinal cords of five individuals with documented clinical evidence of ATCCS and three age-matched controls were obtained. The ATCCS spinal cords were divided into acute/sub-acute (two cases) and chronic (three cases) groups depending on the time to death after their injury; the chronic group was further subdivided according to the epicenter of injury. We counted the motor neurons using light microscopy in 10 randomly selected axial sections at the C7, C8 and T1 spinal cord levels for each group. We also analyzed the lateral and ventral corticospinal tracts (CST) in all groups for evidence of wallerian degeneration and compared them to controls. RESULTS: A primary injury to the lateral CST was present in each case of ATCCS with evidence of wallerian degeneration distal to the epicenter of injury. There was minimal wallerian degeneration within the ventral corticospinal tracts. In the chronic low cervical injury group, there was a decrease in motor neurons supplying hand musculature relative to the other injury groups where the motor neurons sampled at the time of death were not reduced in number when compared to the control group. CONCLUSIONS: We hypothesize that hand dysfunction in ATCCS can be observed after spinal cord injury without any apparent loss in the number of motor neurons supplying the hand musculature as seen in our acute/sub-acute (n=2) and our chronic high injury (n=1) groups. The motor neuron loss seen in the chronic low level injury was felt to be secondary to the loss of C7, C8, and T1 neurons adjacent to the injury epicenter. ( info) |
3/11. Injury to the spinal cord without radiological abnormality (SCIWORA) in adults. Injury to the spinal cord without radiological abnormality often occurs in the skeletally immature cervical and thoracic spine. We describe four adult patients with this diagnosis involving the cervical spine with resultant quadriparesis. The relevant literature is reviewed. The implications for initial management of the injury, the role of MRI and the need for a high index of suspicion are highlighted. ( info) |
| A patient presented with selective paralysis of the arms after having sustained a fall. X-ray of the cervical spine showed a type II odontoid fracture with posterior atlantoaxial dislocation. The diagnosis in the emergency room was cruciate paralysis, which is frequently associated with fractures of axis and/or atlas. However, magnetic resonance imaging (MRI) of the cervical spine revealed a lesion consistent with the acute central cord syndrome (CCS) at the C2-C6 level. The patient underwent posterior atlantoaxial arthrodesis to correct instability and was discharged, without much neurological improvement. Cruciate paralysis has been reported to be associated with fractures of axis and/or atlas, and acute CCS has rarely been associated with the fractures. However, this case illustrates that the lesion responsible for selective paralysis of the upper extremities is not as specific as it had been thought to be, and that it is difficult to accurately identify the level of the cervical cord injury by neurological diagnosis and x-rays alone. Supplementary diagnostic modalities, particularly MRI, are required to make a correct diagnosis and develop a therapeutic strategy. ( info) |
5/11. Cervical cord injury in an elderly man with a fused spine--a case report. We report a case of an elderly man presenting with co-existing diffuse idiopathic skeletal hyperostosis (DISH) and ossified posterior longitudinal ligament (OPLL) resulting in central cord syndrome. Only three such cases have been reported co-existing with DISH. The patient recovered most of his neurological deficit through conservative management. A discussion on the radiological features of DISH co-existing with OPLL and how these differ from ankylosing spondylitis (AS) follows. ( info) |
| Following physical assault, a 71-year-old male suffered apparent cardio-respiratory arrest. Bystander basic life support was provided. Advanced life support including endotracheal intubation was subsequently provided. The patient sustained an injury to the cervical spinal cord, manifesting as central cord syndrome. central cord syndrome is a rare complication of endotracheal intubation and there is no published description following physical assault. This case illustrates that determining precise causality with respect to cervical cord injury may be difficult following standard resuscitation procedures. The pathophysiology of central cord syndrome is reviewed and the possible mechanism in this case, which was the subject of considerable legal debate, is also examined. ( info) |
7/11. Treatment of chronic neuropathic pain after traumatic central cervical cord lesion with gabapentin. central cord syndrome may be associated with severe pain, resistant to conventional pain therapy regimens. chronic pain may be a persistent problem in rehabilitation of spinal cord injuries. These pain syndromes are long lasting and challenging to treat. Gabapentin has been shown to be useful in treatment of different conditions which may be caused by increased neuronal excitability. This report describes a case where central cord syndrome and its chronic neuropathic pain associated with allodynia was successfully treated with gabapentin. ( info) |
8/11. Recurrent central cord syndrome at the level of a solid cervical vertebral fusion. STUDY DESIGN: A case of a solid cervical vertebral fusion that failed to protect against recurrent central cord syndrome at the same spinal level is described. OBJECTIVES: To alert clinicians to the potential for incomplete spinal cord lesions at the same level as cervical vertebral fusions. SUMMARY OF BACKGROUND DATA: The clinical symptomatology of central cord syndrome is discussed and the advantages of T2-weighted magnetic resonance imaging in such cases is considered. No prior reports of central cord syndrome occurring directly posterior to a solidly fused disc segment were found in the literature. methods: The clinical and T2-weighted magnetic resonance imaging features associated with central cord syndrome are presented. The traumatized region developed immediately posterior to the site of an anterior cervical diskectomy and uncovertebral osteophytectomy between the fourth and fifth cervical vertebrae with bone grafting that had been performed more than 3 years earlier. RESULTS: Symptoms of the central cord syndrome resolved over the course of 4 months with no other intervention other than the use of a philadelphia cervical collar. Five years later, the patient remained symptom free. CONCLUSION: This case illustrates that clinicians must be aware of the potential occurrence of central cord syndrome in patients with solidly fused cervical segments, and that cervical fusion does not necessarily protect against future incomplete spinal cord injury, such as central cord syndrome, at the level of the fusion. ( info) |
9/11. Anterior instrumentation for traumatic C1-C2 instability. STUDY DESIGN: Technical note, case report. and review of literature. OBJECTIVE: Description of anterior transarticular internal fixation for traumatic C1-C2 instability. SUMMARY OF BACKGROUND DATA: The currently effective posterior approaches for instrumentation of the C1-C2 junction require considerable soft tissue dissection and prone patient positioning. Some medical and anatomic conditions restrict the posterior approach. MATERIALS AND methods: An odontoid screw and anterior transarticular C1-C2 screws were used to instrument an unstable injury at this junction. The lesion consisted of a type II dens fracture and C1 ring disruption. Two high-quality fluoroscopy machines, a radiolucent OSI fracture table, and the Synframe (Synthes, Paoli, PA) retraction system are used for this procedure. The implant of choice is the 4.0-mm cannulated titanium screw. RESULTS: At 4-month follow-up, successful stabilization without failure of hardware is documented. The patient's neurologic status is stable, with a minor residual left upper extremity motor deficit. The patient has restricted C-spine rotation but no neck pain with movement. CONCLUSION: Anterior stabilization through a standard Smith-Robinson approach of the C1-C2 junction with screws into the odontoid and the lateral masses of C1 is effective. Supine positioning and minimal soft tissue dissection are advantages of this method over standard posterior transarticular instrumentation. knowledge of the local anatomy, strict adherence to the operative protocol, and high-quality fluoroscopy avoid potential surgical complications. ( info) |
| STUDY DESIGN: Case report. OBJECTIVE: To present a patient with central cord syndrome injury after total hip arthroplasty performed under general endotracheal anesthesia. SUMMARY OF BACKGROUND DATA: central cord syndrome, a common injury usually sustained as a result of an extension injury to the cervical spine, often occurs in geriatric patients with underlying spondylotic changes. The injury results in weakness and sensory changes, which are more pronounced in the upper than in the lower extremities. patients with this syndrome experience variable return of function, but some degree of residual deficit and spasticity is likely. methods: The medical record, including the intraoperative anesthesia records, operative notes, progress notes, discharge summary, clinic notes, and radiology studies and reports, was reviewed. RESULTS: The patient developed signs of central cord syndrome after total hip arthroplasty. Despite nonoperative intervention, including physiotherapy, the patient's upper and lower extremity weakness continued. magnetic resonance imaging revealed evidence of cervical cord compression, and the patient underwent a cervical laminectomy, which produced mild improvement in his symptoms. CONCLUSIONS: To avoid life-altering complications, it is important to evaluate the cervical spine (especially in the elderly), avoid neck extension during intubation, and use careful airway management in patients with suspected stenosis/spondylosis. ( info) |