708 THE JOURNAL OF BONE AND JOINT SURGERY A REAPPRAISAL OF ACUTE TRAUMATIC CENTRAL CORD SYNDROME

A review of 77 patients with traumatic central cord syndrome revealed that atypical variations are more common than the existing literature suggests and that these may be seen in a wide variety of acute injuries to the cervical spine. In general the outcome is good; a favourable prognosis on admission is suggested by good hand function, hyperpathia, Lhermitte’s sign and normal perianal sensation. The study has highlighted the value of regular muscle charting and has cast doubt on previous neuroanatomical assumptions about the syndrome. Central cord syndrome is the commonest of the incomplete traumatic cervical cord syndromes, the others being the Brown-S#{233}quard syndrome and the anterior cord syndrome. As originally defined by Schneider, Cherry and Pantek (1954), the central cord syndrome is characterised by motor impairment which is disproportionately greater in the upper limbs than in the lower, by bladder dysfunction (most often urinary retention) and by a variable degree of sensory loss below the level of the cord lesion. These authors and others (Taylor and Blackwood 1948) found the syndrome to be most common in older subjects with cervical spondylosis and hyperextension injuries. A number ofseries included no patients with bony injuries but it had been noted originally that the syndrome did also occur with fractures and fracture-dislocations; subsequently this association ‘received scant attention. This report aims to draw attention to the variability of the central cord syndrome in a wide range of injuries to the cervical spine, and to ascertain which clinical features may be of prognostic significance