Corpus: Anterior spinal artery syndrome

Spinal anterior artery syndrome refers to the symptoms caused by reduced blood flow in the anterior spinal artery.

See also: Spinal cord infarction

It is a rare disease, but the most common form of spinal cord ischaemia.

There are numerous causes of spinalis anterior syndrome, including:

• Vascular causes: Occlusion of the vessel due to
  • arteriosclerosis
  • thrombosis, embolism
  • Microangiopathy in diabetes mellitus
  • Vasculitis (e.g. syphilitic vasculitis)
  • Spinal AV fistula
  • Diseases of the aorta (e.g. aortic aneurysm or dissection)
• Trauma: mechanical compression of the anterior spinal artery by
  • median disc herniation
  • tumour in the spinal canal
  • Vertebral body fracture
• Iatrogenic causes
  • Vascular surgery
  • Spinal anaesthesia
  • Spinal angiography
• Massive blood loss with hypotension

The common pathophysiological pathway of all causes is that the anterior and lateral cords in the spinal cord are damaged by reduced blood flow in the anterior spinal artery.

Spinal anterior artery syndrome is characterised by paraparesis and disorders of bladder and rectal function.

Furthermore, a dissociated sensory disturbance caudal to the lesion is reported, i.e. the sensation of pain and temperature (protopathic sensibility) are disturbed, while the sensation of position, vibration and touch (epicritical sensibility) are not impaired. In the case of small ischaemias, the disruption of protopathic sensitivity may only be evident at lesion level due to isolated damage to the anterior commissure.

Girdle-shaped paraesthesia and pain are frequently reported initially.

The symptoms usually occur acutely.

The differential diagnosis should include a mechanical lesion of the spinal cord caused by a tumour, a fracture, syringomyelia and a herniated disc.

However, myelitis, funicular myelosis and multiple sclerosis can also lead to similar symptoms.

Lériche syndrome should also be ruled out. A tumour in the area of the frontal brain (mantle edge syndrome) can also cause similar symptoms.

Anamnesis and clinical examination are fundamental. Imaging diagnostics should include a computer tomogram or magnetic resonance tomogram.

If necessary, further diagnostics should be performed (e.g. angiography if an AV fistula is suspected).

Thrombosis prophylaxis is mandatory and a bladder catheter should be inserted if necessary. In addition, an antiplatelet agent (e.g. ASA) is usually administered, although this does not or only slightly improves the symptoms. An underlying disease should be treated.

Physiotherapy and occupational therapy should also be carried out.

The prognosis is often poor, as the spinal cord only tolerates ischaemia for a very short time. Paraparesis, sensory disturbances and bladder and rectal dysfunction are usually irreversible.