Not all spinal cord injuries involve a fracture.

A middle-aged unrestrained driver involved in a minor motor vehicle crash arrived in the emergency department in complete spinal immobilization. The patient was initially moving both arms and legs spontaneously to commands, crying out in pain and complaining of pain out of proportion to his physical injuries. The only visible injury was a minor abrasion to the forehead. Spinal cord injuries related to trauma are not always obvious. Central cord syndrome (CCS) should be included in the differential diagnosis for spinal cord injuries, even with a minor hyperextension injury without a cervical spine fracture. This case study outlines the etiology, pathophysiology, diagnostic tests, and management of a patient with CCS.