Anterior spinal artery syndrome

a schematic

diagram showing anatomical signification of uncomplete cord injuries

Ventral cord

syndrome • Spinal cord infarct - Ganzer Fall bei Radiopaedia

Di Muzio, B. Spinal cord infarct. Case study, Radiopaedia.org. (accessed on 07 Nov 2022) https://doi.org/10.53347/rID-57072 • CC by-nc-sa 3.0 (modified)

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Ventral cord syndrome (also known as anterior cord syndrome) is one of the incomplete cord syndromes and affects the anterior parts of the cord resulting in a pattern of neurological dysfunction dominated by motor paralysis and loss of pain, temperature and autonomic function. Anterior spinal artery ischemia is the most common cause.

Terminology

Ventral cord syndrome encompasses all causes of damage to the anterior spinal cord regardless of etiology (see below). In contrast, anterior spinal artery syndrome, also known as Beck's syndrome, denotes a ventral cord syndrome specifically due to ischemia/infarction of the anterior two-thirds of the spinal cord due to involvement of the anterior spinal artery.

Clinical presentation

Involvement of the anterior half to two-thirds of the spinal cord results in a predictable pattern of neurological impairment consisting of:

complete motor paralysis below the level of the lesion due to involvement of the anterior horn cells and corticospinal tracts
loss of pain and temperature at and below the level of injury due to involvement of spinothalamic tracts
autonomic dysfunction: orthostatic hypotension due to involvement of lateral horn cells
bladder and bowel dysfunction and sexual dysfunction may arise depending on the level of the lesion

Importantly 2-point discrimination, proprioception and vibratory senses are normal due to intact posterior columns and posterior grey matter.

Pathology

Ventral cord syndrome is caused by a variety of processes, the most common one being ischemia due to occlusion of anterior spinal artery, which in turn is the result of a number of underlying processes. As such, the list of causative pathologies is very similar to that of acute spinal cord ischemia syndrome.

Causes of ventral cord syndrome include :

ischemia/infarction (anterior spinal artery syndrome)
- atherosclerotic thromboembolism
- aortic pathology
  - aortic aneurysm
  - aortic thrombosis
  - aortic dissection
  - aortic surgery/intervention
- anterior spinal artery pathology
  - penetrating trauma (e.g. stabbing)
  - arterial dissection (e.g. catheter angiography)
  - fibrocartilaginous embolism
external compression/damage of the anterior spinal cord
- herniated disc
- spinal tumor (e.g. intrathecal extramedullary)
- epidural collections (e.g. epidural hematoma and epidural abscess)
- kyphoscoliosis
- trauma
  - vertebral body fractures
  - direct stab injuries

Radiographic features

For a description of the imaging features please refer to acute spinal cord ischemia syndrome.

Treatment and prognosis

Prognosis of anterior cord syndrome is worst among all other spinal cord injury syndromes . It is associated with high mortality and poor functional outcome in terms of poor recovery of motor power and coordination.

Treatment is focused on treating the primary cause of anterior spinal artery insufficiency and general supportive treatment and care.

History and etymology

The anterior cord syndrome is thought to have been initially described Schneider in 1955 in the English literature although there are reports of this being described by K Beck in German literature in 1952 .