Anterior spinal artery syndrome

Anterior cord syndrome arises from damage to the spinothalamic and corticospinal pathways. 

Occurs due to injury of the anterior spinal artery (ASA) affecting the anterior two-thirds of the spinal cord.

The anterior spinal artery (ASA) is the amalgamation of the vertebral arteries with co-lateral blood flow from several radicular arteries (the artery of Adamkiewicz is the most important of these!). This leaves multiple areas of the cord vulnerable to watershed ischemia.

The spinal cord receives blood supply from two posterior arteries (25%) and one anterior spinal artery (75%)

This damage manifests as:

Loss of motor function (flaccid paralysis), pain and temperature/ sensation loss distal to the lesion.

***Only vibration, position, and tactile sensation are preserved (as posterior column remains intact).

Potential causes:

  1. C-spine injury
  2. Thrombosis causing ischemic injury to ASA
  3. Anterior cord compression from extrinsic mass 
  4. Aortic dissection or hypotension
  5. AAA repair [stats]

NOTE: The overall prognosis for recovery of function is poor.

REFERENCES

  1. Steven Go. Chapter 258: Spine Trauma. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e
  2. Grecu L, Schonberger RB. Vascular Disease In: Barash PG, Cullen BF, Stoelting RK, Cahalan M, Stock MC, eds. Clinical Anesthesia, 6th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2009: Ch. 8.
  3. Foo, D; Rossier, AB (Feb 1983). “Anterior spinal artery syndrome and its natural history.”. Paraplegia. 21 (1): 1–10.
  4. Norris EJ. Anesthesia for Vascular Surgery. In: Miller RD, Eriksson LI, Fleisher L, Wiener-Kronish JP, Cohen NH. Miller’s Anesthesia, 8th ed. Philadelphia, PA: Elsevier Saunders; 2014: Ch. 69

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