Location
Philadelphia, PA
Start Date
3-5-2023 1:00 PM
End Date
3-5-2023 4:00 PM
Description
Setting: Outpatient pain management office
Case Diagnosis: A 30-year-old man presents with central cord syndrome (CCS) after cervical spine trauma.
Introduction: Central cord syndrome (CCS) is most commonly caused by cervical spine trauma with an incidence of 11,000 cases annually in the United States. Despite CCS being the most common type of incomplete spinal cord injury, treatment is still controversial and varies from conservative management to early surgical intervention.
Case Description: After sustaining a closed head trauma by 350 lb lead object at work, the patient presented with weakness, numbness, and tingling in the bilateral upper and lower extremities and demonstrated the typical signs of CCS where the motor impairment of upper extremities was disproportionate compared to the lower extremities. Imaging studies and clinical examination findings were used to support the diagnosis of CCS with neurological level of injury at C4 along with neurogenic bladder and bowel. On day 6, he underwent C3-C4 posterior cervical laminectomy for spinal cord decompression. After surgery, he regained movement in his upper and lower extremities and went through rehabilitation, physical therapy, and occupational therapy. Treatment included pregabalin, lidocaine patch, diclofenac gel, infrared heating pad, and medical marijuana.
Results: Magnetic resonance imaging (MRI) of cervical spine showed focal cord edema at C4 level, likely due to contusion. At 7 months post C3-C4 laminectomy, patient continued to demonstrate decreased sensation in the upper and lower extremities bilaterally (left > right), clonus in left upper extremity, and brisk reflexes in both upper and lower extremities but improved muscle strength. Occupational therapist noted slow progression with improving hand grip strength.
Discussion: This case illustrates that early surgical intervention can prevent paralysis after a spinal cord injury and improve recovery of CCS. Rapid recognition of neurological deficits and diagnosis of CCS is important for the early management of incomplete spinal cord injury and the patient’s prognosis and recovery.
Embargo Period
6-7-2023
Included in
Machine Operator with Central Cord Syndrome: A Case Report
Philadelphia, PA
Setting: Outpatient pain management office
Case Diagnosis: A 30-year-old man presents with central cord syndrome (CCS) after cervical spine trauma.
Introduction: Central cord syndrome (CCS) is most commonly caused by cervical spine trauma with an incidence of 11,000 cases annually in the United States. Despite CCS being the most common type of incomplete spinal cord injury, treatment is still controversial and varies from conservative management to early surgical intervention.
Case Description: After sustaining a closed head trauma by 350 lb lead object at work, the patient presented with weakness, numbness, and tingling in the bilateral upper and lower extremities and demonstrated the typical signs of CCS where the motor impairment of upper extremities was disproportionate compared to the lower extremities. Imaging studies and clinical examination findings were used to support the diagnosis of CCS with neurological level of injury at C4 along with neurogenic bladder and bowel. On day 6, he underwent C3-C4 posterior cervical laminectomy for spinal cord decompression. After surgery, he regained movement in his upper and lower extremities and went through rehabilitation, physical therapy, and occupational therapy. Treatment included pregabalin, lidocaine patch, diclofenac gel, infrared heating pad, and medical marijuana.
Results: Magnetic resonance imaging (MRI) of cervical spine showed focal cord edema at C4 level, likely due to contusion. At 7 months post C3-C4 laminectomy, patient continued to demonstrate decreased sensation in the upper and lower extremities bilaterally (left > right), clonus in left upper extremity, and brisk reflexes in both upper and lower extremities but improved muscle strength. Occupational therapist noted slow progression with improving hand grip strength.
Discussion: This case illustrates that early surgical intervention can prevent paralysis after a spinal cord injury and improve recovery of CCS. Rapid recognition of neurological deficits and diagnosis of CCS is important for the early management of incomplete spinal cord injury and the patient’s prognosis and recovery.