Anterior Cord Syndrome

What is Anterior Cord Syndrome?

Anterior cord syndrome is a spinal lesion affects the anterior region of the spinal cord, which causes loss of motor control integrated with crude sensation. The exact location of lesion development is at the anterior two-thirds of the spinal cord due to ischemic injury caused by a vascular lesion at the anterior spinal artery.

Affected individuals have completely defective motor functionality commences beneath the lesion formation. Along with this, sensory defects leads to defective pain and temperature perception. The intensity of the loss of sensory perception depends on the complexity of lesion present in the spinal cord, as well as the involvement of spinal cord^1,2,3.

Symptoms

• All the symptoms are related to loss of motor functionality, sensory deficits, conservation of perception and joint posture sensation.
• The severity of the symptoms is related to the site and degree of lesion present in the spinal cord. Frankel B or B on the ASIA impairment scale can measure the related to motor loss and sensory deficits, though these scales are not useful for distinguishing the types of sensory deficits, including perception, sense of joint positioning, pain or temperature sensation etc.
• The deficits of sensory perception include loss of pinprick or temperature sensation. Both pain and temperature sensation depend upon spinothalamic tracts, whereas tactile, vibration and joint position sense are supplied by the dorsal columns. The defective sensory functions can recover depending upon the lesion position and involvement of spinal cord.
• Some patients can lose their body awareness due to anterior cord lesions, but proper rehabilitation process may revive the patient’s condition. All the related sensory sparing arise due to incomplete lesion development at the anterior spinal cord. However, it is possible that Anterior Cord Syndrome affected patients only involves in loss of motor function without loss of sensation.
• There is also a risk of development of autonomic dysreflexia, gait impairment, neuropathic pain, sexual dysfunction, and neurogenic bladder, bowel, and skin depending on the degree of injury.
• Chest pain with altered ECG has been identified if infraction develops in C7 to T1 of spinal cord^1,4,5,6.

Causes

Loss of blood flows into the anterior two-thirds of the spinal cord resulting Anterior Cord Syndrome. Loss of blood flow into the anterior two-thirds of the spinal cord can be developed due to emboli or thrombus formation at the anterior spinal artery (ASA). This can happen as postoperative secondary complications in adults. The operative intervention may conduct for repairing of an abdominal aortic aneurysm¹.

There are two main causes involve in Anterior cord syndrome. They are traumatic and non-traumatic.

Traumatic

Traumatic injury may occur due to road accidents because of faulty driving or uncontrolled traffic issue. Usually, accidental trauma provides compression injury or forced flexion and resultant of this lesion formation at the anterior part of the spinal cord.

Non-traumatic

Lesion formation at the anterior part of the spinal cord can also arise due to infraction development. The multiple factors are responsible for the development of infraction, which includes thrombus formation at the anterior spinal artery, aortic aneurysm rupture and/or spinal cord angioma. Less frequently, neurological damage in the spinal nerve may also a contributory factor for the development of anterior cord syndrome⁴.

Diagnosis

Initial diagnosis of Anterior Cord Syndrome is started with physical examination and the classical diagnostic tool is X-Ray.

X-Ray

Entire spine X-ray usually conducted to locate the problem. But precise diagnosis may not possible with X-ray.

CT Scan

In some cases, doctors prefer to go for Computerized Tomography scan or CAT scan after examining the physical condition and symptomatic analysis. Computerized Tomography provides the imaging of bony anatomy of the spine.

MRI

Magnetic Resonance Imaging helps to detect the thrombus formation or other masses that may cause compression of the spinal cord.

All these imaging tools are useful to detect the actual location of the lesion and also exclude other possibilities of spine injury⁷.

Treatment

• The indoor hospital service requires treating anterior cord syndrome at the initial stage. But effective and comprehensive rehabilitation management is the ultimate necessity of patients suffering from anterior cord syndrome.
• Trained therapist who expert in intensive physical therapy, occupational therapy, and psychological support should provide adequate treatment with close supervision of medical assistant require for long-term management of the affected individual with anterior cord syndrome.
• Patients and family members should aware about the sign and symptoms and precautionary factors and for this provision of relative education requires minimizing the risk of further complication or accidental trauma.
• Patients may require the medical device to assist their movement and activities of daily living depending upon the degree of injury
• The long-term treatment and related support require for managing spasticity, mobility impairment, neuropathic pain, and neurogenic bladder, bowel, and skin¹.

References

1. Merrine Klakeel, Justin Thompson, Rajashree Srinivasan, Frank McDonald; Anterior spinal cord syndrome of unknown etiology; Proc (Bayl Univ Med Cent). 2015 Jan; 28(1): 85–87; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264724/
2. Ramelli GP, Wyttenbach R, von der Weid N, Ozdoba C. Anterior spinal artery syndrome in an adolescent with protein S deficiency. J Child Neurol. 2001;16(2):134–135.
3. Kirshblum S, Campagnolo DI. Spinal Cord Medicine. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2011:93–94.
4. Anterior Cord Syndrome; physiotherapy-treatment.com; http://www.physiotherapy-treatment.com/anterior-cord-syndrome.html
5. Michael T Mullen, Michael L Mc Garvey, Spinal cord infarction: Clinical presentation and diagnosis; http://www.uptodate.com/contents/spinal-cord-infarction-clinical-presentation-and-diagnosis
6. Nakae Y, Johkura K, Kudo Y, Kuroiwa Y. Spinal cord infarction with cervical angina. J Neurol Sci 2013; 324:195.
7. Spinal Cord Injury; American Association of Neurological Surgeons; http://www.aans.org/patient%20information/conditions%20and%20treatments/spinal%20cord%20injury.aspx