General
- AKA anterior spinal artery syndrome.
Aetiology
- Cord infarction in the territory supplied by the anterior spinal artery.
- Occlusion of the anterior spinal artery,
- Anterior cord compression by
- Dislocated bone fragment, or
- Traumatic herniated disc.
Numbers
- More common than central cord syndrome.
Clinical features
- Paraplegia (if higher than ≈ C7) quadriplegia
- Due to anterior horn involvement but the corticospinal tract
- Dissociated sensory loss below lesion
- Loss of pain and temperature sensation (spinothalamic tract lesion)
- Preserved two-point discrimination, joint position sense, deep pressure sensation (posterior column function)
Evaluation
- It is vital to differentiate a non-surgical condition (e.g. anterior spinal artery occlusion) from a surgical one (e.g. anterior bone fragment).
- This requires one or more of: myelography, CT, or MRI.
Treatment
- Surgical indication
- Evidence of cord compression (e.g. by large central disc herniation) or
- Spinal instability (ligamentous or bony).
Prognosis
- Worst prognosis of the incomplete injuries.
- 10–20% recover functional motor control.
- Sensation may return enough to help prevent injuries (burns, decubitus ulcers…).