Guideline sources The following summarized guidelines for the evaluation and management of central cord syndrome (CCS) are prepared by our editorial team based on guidelines from the Congress of Neurological Surgeons (CNS/AOSpine 2017) and the American Association of Neurological Surgeons (AANS/CNS 2013). 1 2 3 3 3 4 Definition CCS is an incomplete traumatic spinal cord injury characterized by preferential upper extremity motor impairment and bladder dysfunction. 3 Epidemiology In younger patients (< 40-50 years of age), CCS is associated with high-speed motor vehicle collisions, falls, athletic injuries, diving, assault, or gun-shot wounds, whereas low energy trauma (including falls from standing height) is the main mechanism in older patients (> 45-50 years of age). 3 Disease course Clinical manifestations include disproportionately greater upper extremity weakness compared with lower extremity weakness, bladder dysfunction, urinary retention, and varying degree of sensory loss below the level of the lesion. Neurogenic shock (bradycardia, hypotension) may also be present. 3 Prognosis and risk of recurrence https://web.pathway.md/diseases/recrlYeO5h0QSMtnr 1/3 6/29/23, 3:46 AM Central cord syndrome Pathway The overall in-hospital mortality rate for CCS is estimated at 2.6%. 4 Guidelines 1. Diagnostic investigations Cardiorespiratory monitoring: maintain mean arterial BP at 85 to 90 mmHg during the first week after spinal cord injury to improve spinal cord perfusion, and implement close medical, cardiac, hemodynamic, and respiratory monitoring. B 2. Medical management Setting of care: admit patients with acute traumatic CCS to an ICU, particularly patients with severe neurological deficits. B 3. Surgical interventions Surgical decompression: perform surgical decompression of the compressed spinal cord, particularly if the compression is focal and anterior. B Timing of surgery: consider early surgery ( 24 hours after injury) in adult patients with traumatic CCS. C Reduction of fracture-dislocation injuries: perform early reduction of fracture-dislocation injuries. B References 1. Aarabi B, Hadley MN, Dhall SS et al. Management of acute traumatic central cord syndrome ATCCS . Neurosurgery. 2013 Mar;72 Suppl 2 195 204. Open 2. Fehlings MG, Tetreault LA, Wilson JR et al. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury and Central Cord Syndrome: Recommendations on the Timing ( 24 Hours Versus 24 Hours) of Decompressive Surgery. Global Spine J. 2017 Sep;7 3 Suppl):195S 202S. Open 3. Sohaib Z Hashmi, Angelo Marra, Louis G Jenis et al. Current Concepts: Central Cord Syndrome. Clin Spine Surg. 2018 Dec;31 10 407 412.2018 Dec;31 10 407 412. Open 4. David W Brodell, Amit Jain, John C Elfar et al. National trends in the management of central cord syndrome: an analysis of 16,134 patients. Spine J. 2015 Mar 1;15 3 435 42.2015 Mar 1;15 3 435 42. Open 5. Sohaib Z Hashmi, Angelo Marra, Louis G Jenis et al. Current Concepts: Central Cord Syndrome. Clin Spine Surg. 2018 Dec;31 10 407 412. Open https://web.pathway.md/diseases/recrlYeO5h0QSMtnr 2/3 6/29/23, 3:46 AM Central cord syndrome Pathway 6. David W. Brodell, Amit Jain, John C. Elfar et al. National Trends in the Management of Central Cord Syndrome; An Analysis of 16,134 patients. Spine J. 2015 Mar 1; 15 3 435 442. Open https://web.pathway.md/diseases/recrlYeO5h0QSMtnr 3/3