Pathophysiology and surgical decision-making in central cord syndrome and degenerative cervical myelopathy: correcting the somatotopic fallacy

Frontiers in Neurology, 2023 · DOI: 10.3389/fneur.2023.1276399 · Published: November 17, 2023

Simple Explanation

Central Cord Syndrome (CCS) is a spinal cord injury causing more weakness in the arms than legs. Our understanding of CCS is changing, especially regarding how the spinal cord is organized. Older ideas suggested CCS was a focal injury, but new evidence points to it being a more widespread issue. Also, it's becoming more common to see CCS in older adults who already have Degenerative Cervical Myelopathy (DCM). Decisions about when to do surgery for CCS are varied, and it's important to figure out how to best treat CCS when someone also has DCM. This review looks at new findings and suggests more research is needed.

Study Duration

Not specified

Participants

186 patients (meta-analysis) and illustrative case studies

Evidence Level

Mini Review

Key Findings

1
The traditional understanding of the spinal cord's organization, where specific areas control specific body parts, is likely incorrect, suggesting CCS is a more diffuse injury.
2
Early surgery (within 24 hours) for CCS may lead to better outcomes, especially for patients with certain levels of injury severity.
3
There is a growing overlap between CCS and DCM due to an aging population, requiring a comprehensive understanding of both conditions for effective patient care.

Research Summary

This review summarizes recent advances in understanding the pathophysiology and management of CCS, highlighting its increasing overlap with DCM. It challenges the traditional somatotopic arrangement of the CST in the cervical cord, suggesting that CCS represents a diffuse injury akin to DCM. Assessment of CCS in the context of DCM is challenging, but the increased use of quantitative assessment tools for limb function may aid in differentiating acute injury from chronic conditions. A consensus definition of CCS is needed for equitable patient care. The review recommends early surgery for CCS patients, in line with current guidelines, and emphasizes the need for ongoing research to refine treatment strategies for this evolving patient population. Understanding the relationship between pre-existing DCM, CCS severity, and recovery trajectory is crucial.

Practical Implications

Refined Diagnostic Criteria

Develop and implement a consensus definition of CCS to ensure consistent patient identification and treatment across different clinical settings.

Early Surgical Intervention

Consider early surgical decompression (within 24 hours) for CCS patients, especially those with specific injury profiles, to potentially improve upper limb recovery.

Comprehensive Assessment Strategies

Incorporate quantitative assessment tools for both upper and lower extremity function in patients with DCM to better differentiate acute CCS from chronic myelopathy, guiding more tailored treatment plans.

Study Limitations

1
Lack of widely accepted or validated diagnostic criteria for CCS.
2
Variability in surgeon preferences regarding the timing of surgery for CCS.
3
Limited research on the specific impact of pre-existing DCM on the recovery trajectory of patients with acute CCS.

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