Central cord syndrome is MOST often associated with which mechanism of injury?

• A. Hyperextension of the cervical spine
• B. Axial loading of the cervical spine
• C. Hyperflexion of the cervical spine
• D. Compression of the cervical spine

Answer: (A)

Central cord syndrome occurs most often after a hyperextension injury to the cervical spine, especially in older adults with cervical spondylosis. When the neck extends in the presence of canal stenosis, the central region of the cord—the area containing the neurons that control the arms and the crossing fibers of pain and temperature—sustains the most injury. The result is disproportionately greater weakness and sensory changes in the upper extremities compared with the lower extremities, with bladder function often spared early. Hyperextension thus explains why the central portion of the cervical cord is damaged and why the arms are more affected. Hyperflexion and axial loading tend to produce different injury patterns (such as anterior cord involvement or burst compression), so they’re less likely to cause the central pattern seen here.