Makindo Medical Notes

Related Subjects: | Transverse myelitis | Acute Disseminated Encephalomyelitis |Cervical spondylosis |Spinal Cord Anatomy |Acute Disc Prolapse |Spinal Cord Compression |Spinal Cord Haematoma |Foix-Alajouanine syndrome |Cauda Equina |Conus Medullaris syndrome |Anterior Spinal Cord syndrome |Central Spinal Cord syndrome |Brown-Sequard Spinal Cord syndrome

Anterior Spinal Cord Syndrome (ASCS) is a type of incomplete spinal cord injury that results from damage to the anterior two-thirds of the spinal cord. This syndrome is characterized by the loss of motor function and pain and temperature sensation below the level of injury, while proprioception (sense of position) and vibratory sensation are typically preserved. ASCS often results from ischaemia due to disruption of the anterior spinal artery, but can also be caused by trauma, compression, or other etiologies.

Introduction

• Spinal cord infarction is an uncommon condition
• Anterior spinal artery, narrowest in the thoracic segment

Cause

• Ischemia: occlusion or hypoperfusion of the anterior spinal artery. This may occur during aortic surgery, from aortic dissection, or due to severe hypotension.
• Trauma: Direct injury to the anterior portion of the spinal cord, often from vertebral fractures or dislocations, especially in the cervical or thoracic spine.
• Disc Herniation: A large herniated disc can compress the anterior spinal cord, leading to ASCS.
• Spinal Tumours: Tumours compress the anterior portion of the spinal cord or compromise blood flow from the anterior spinal artery.
• Infections: spinal abscesses or transverse myelitis can lead to anterior spinal cord damage.
• Vascular Malformations: Arteriovenous malformations (AVMs) or aneurysms involving the anterior spinal artery.

Anatomy

Clinical

• Paraparesis or quadriparesis
• Sparing of vibration and proprioceptive sense

Investigations

• MRI: imaging modality of choice, shows extent of the spinal cord injury, presence of ischaemia, or any compressive lesions such as tumours or herniated discs.
• Computed Tomography (CT): to assess bony injuries, such as fractures or dislocations, particularly in trauma cases.
• Spinal Angiography: may be used to evaluate vascular causes, such as anterior spinal artery occlusion or arteriovenous malformations.

Management

• ABC, resuscitation, IV fluids. Stabilization of the spine in cases of trauma to prevent further injury.
• High-dose corticosteroids in acute spinal cord injury, use is controversial and should be evaluated on a case-by-case basis.
• Vascular interventions, such as surgery or endovascular procedures, for ischaemic causes.
• Surgical Decompression: if spinal cord compression due to disc herniation, tumours, or haematomas.
• Physical and occupational therapy to maximize recovery of motor function and adapt to deficits. Bowel and bladder management to address autonomic dysfunction. Preventing complications such as pressure ulcers, deep vein thrombosis, and infections.