Central Cord Syndrome



Incomplete spinal cord injury secondary to trauma


Motor weakness upper limb > lower limb


Lower extremity motor score [LEMS] - upper extremity motor score [UEMS] ≥ 5




Most common pattern cord injury

- 25% of all spinal cord injuries


Bimodal age distribution

1. <45

- high velocity injury

- vertebral fractures


2. Older patients with low energy injuries

- pre-existing cervical degeneration and stenosis

- simple fall with hyper-extension injury


Usually C3/4 and C4/5




Spinal cord anatomy


Dorsal Columns 

- light touch, vibration & proprioception

- cervical fibres central, sacral fibres lateral


Lateral Corticospinal Tract

- motor tract

- cervical fibres central, sacral fibres peripheral




Central cord


Injury of central gray matter

- affects upper limb tracts > lower limb tracts

- distal affected more than proximal

- LMN in arms 

- UMN in legs

- sacral sparing common




Usually normal




MRI central cord syndrome 1MRI central cord syndrome 2




Cord injury

- high signal intensity on T2

- localise level of injury


Natural history


Usually regain walking and bladder function

Hands have the worst prognosis




Aarabi et al J Neurosurg Spine 2011

- 42 patients, 82% men, average age 58

- admission ASIA scores and midsagittal diameter of cord most related to prognosis




Operative versus nonoperative management


Aito et al Spinal Cord 2007

- 82 patients with acute traumatic central cord syndrome

- 45% treated surgically

- no difference in long-term neurological outcome


Chen et al Spine 1998

- 37 patients with acute traumatic central cord syndrome

- 16 treated surgically

- immediate neurological improvement / better long-term neurological outcome with surgery

- 60% nonoperative group improved to at least grade 3 over time


Early versus late decompression


Badhiwala et al JAMA Surg 2022

- 186 patients undergoing surgery for central cord syndrome

- improved upper limb function at one year with early surgery


Aarabi et al J Neurotrauma 2021

- 101 patients over 19 year period

- no difference in outcomes with decompression < 24 hours, < 72 hours, > 72 hours


Andersen et al Neurosurg 2015

- systematic review of 9 studies

- evidence of improved outcomes with surgery < 2 weeks post injury




Spinal cord injury management

- maintain blood pressure / steroids


If early improvement - non operative treatment


No improvement - operative management