Anterior Cord Syndrome

Introduction

Anterior cord syndrome referred to as Anterior spinal artery syndrome (ASAS) or ventral cord syndrome (VCS). ASAS is an incomplete spinal cord injury(SCI) that is often related to flexion injuries of the cervical region that result in infarction of the ventral two thirds of the cord and/or its vascular supply from the anterior spinal artery. Patients present with impairments in the pain and temperature sensations while the vibration and proprioception sensation is preserved. Motor deficits are observable both at and below the level of injury.

Clinically Relevant Anatomy

ASAS is caused by ischemia within the anterior spinal artery (ASA), which supplies blood to the anterior 2/3rd of the spinal cord. The anterior spinal artery, with a few radicular artery contributions, supplies blood to the bilateral anterior and lateral horns of the spinal cord, as well as the bilateral spinothalamic tracts and corticospinal tracts. The anterior horns and corticospinal tracts control the somatic motor system from the neck to the feet. The lateral horns span T1-L2 of the spinal cord and sheathe the neuronal cell bodies of the sympathetic nervous system. The spinothalamic tracts carry pain and temperature sensory information.

Aetiology

1. Spinal cord crush injury
2. Epidural Hematoma related pressure injury
3. Hyperflexion injury in athletes (if bony instability) with herniation of dislocated vertebral body fragments or acutely herniated discs compressing the anterior spinal artery and spinal cord.
4. Anterior Spinal Artery compression with secondary cord ischemia.
   1. Vascular disease-Aortic surgery or atherosclerotic disease as seen in the elderly
   2. Cross-Clamping aorta

Differential Diagnosis

• Central cord syndrome
• Dorsal cord syndrome
• Brown-Séquard syndrome
• Conus medullaris syndrome
• Cauda equina syndrome
• Transverse myelitis
• Guillain-Barré syndrome
• Multiple sclerosis
• Spinal epidural abscess
• Epidural hematoma
• Disk herniation
• Spinal cord neoplasm
• Meningitis/encephalitis