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Recovery of hand function is variable.
78%
4391/5638
Almost all patients regain normal hand function if surgery is performed within 24 hours
6%
316/5638
The majority of patients remain wheelchair dependent following this injury
1%
47/5638
Recovery of upper extremity function typically occurs before recovery of lower extremity function.
13%
726/5638
The recovery of hand function depends on early administration of corticosteroids.
69/5638
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This patient has central cord syndrome. Recovery of hand function is variable. Central cord syndrome is the most common incomplete spinal cord injury syndrome. Upper limbs are more affected because of the peripheral location of sacral structures in the lateral corticospinal tract. Restoration of hand function is variable and in some patients, hand function does not recover. Hand impairment is the most common long-term disability associated with CCS. Although most patients achieve major neurologic improvements, some face considerable long-term functional impairment. Nowak et al. reviewed central cord syndrome. They report spinal instability is the only absolute indication for surgery because instability can worsen secondary injury (dynamic factor). They define instability is defined as angular displacement > 11deg compared with adjacent vertebrae, or vertebral body translation >3.5mm. Dvorak et al. reviewed traumatic central cord syndrome. Predictors for motor recovery include higher initial motor (ASIA) score, level of formal education (higher education, better recovery), and spasticity at follow-up (although this had poorer quality of life). Factors that did not affect recovery include steroid administration, mechanism of injury and gender. Merriam et al. reviewed 77 cases of acute CCS. Regarding intrinsic muscle function in the hand, they found that 18/23 patients with MRC grade 4 and above at presentation had good outcome. However, only 10% of those with grade 1-3 at 1 to 6 weeks after injury had good results. Figure A is a sagittal T2-weighted MRI showing minimal disc protrusion at C4-5 and C5-6, with spondylotic spinal stenosis but no cord myelomalacia. Figure B shows the axial image at level C4-5 showing obliteration of CSF space around the cord with significant stenosis as evidenced by loss of CSF signal and severely diminished AP diameter of the canal. Illustration A shows the cross sectional anatomy of the spinal cord with the central location of upper extermity structures in the lateral corticospinal tract. Incorrect Answers: Answer 2: The mainstay of treatment of CCS is nonoperative. Surgery does not lead to improved prognosis of the upper extremity function. Answer 3: Approximately 75-85% of patients recover independent ambulation. Answer 4: Lower extremity function recovers before upper extremity function. Answer 5: Hand function is the last to recover and recovery is unpredictable. The recovery of hand function has not been shown to depend on steroid administration.
4.6
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