Anatomy of spinal cord vascularization, aortic branches on the right and spinal cord arteries on the left. It arises from branches of the vertebral arteries and courses along the anterior aspect of the spinal cord. Anterior spinal artery syndrome synonyms, anterior spinal artery syndrome pronunciation, anterior spinal artery syndrome translation, english dictionary definition of anterior spinal artery syndrome. Anterior spinal artery definition of anterior spinal. Anterior spinal artery syndrome the spinal cord receives blood supply from two posterior arteries 25% and one anterior spinal artery 75%. In the region of the pons, both vertebral arteries merge to form the single basilar artery. The anterior spinal artery supplies the anterior portion of the spinal cord and arises from the vertebral artery in the region of the medulla oblongata. As the anterior spinal artery proceeds inferiorly, it receives branches originating mostly from the aorta. Reversible paraplegia after minimally invasive spine surgery j. Consistent with its functional neuroanatomy, an asa infarct typically presents as loss of motor function and paintemperature sensation, with relative sparing of proprioception and vibratory sense below the level of the lesion 11. In the present literature on minimally invasive surgery, no anterior spinal artery syndrome has been yet described as complication. The left and right anterior spinal arteries are initially branches from the vertebral arteries, but as they descend to the hindbrainspinal cord junction, they merge into a single midline artery that runs along the ventral surface of the spinal cord in the anterior median sulcus.
There are many causes for an anterior spinal artery syndrome, for example, mikroangiopathia, duralavfistula, vasculitis, or the injuryembolism of. In both cases intraoperative seps were normal and the wakeup test revealed no neurological deficit. Anterior spinal artery syndrome complicated by the ondine. Anterior spinal artery syndrome the most common clinical presentation of a spinal cord infarction is anterior spinal artery asa syndrome. When the cervical spine is involved, breathing disorders may be observed. Between january 1, 1980, and june 30, 1989, 9 patients 6 males and 3 females developed ischemic injury to the spinal cord or lumbosacral plexus following 3,320 operations on the abdominal aorta. Surgical view of the lumbar arteries and their branches.
Treatments for anterior spinal artery syndrome including drugs, prescription medications, alternative treatments, surgery, and lifestyle changes. The cause of this syndrome is destruction of certain portions of the spinal cord by a sudden occlusion of the anterior spinal artery or its branches. Spinal cord infarction is much less frequent than cerebral infarction, accounting for only 1% of all strokes. Anterior spinal artery syndrome, which may result from arterial compression, hypotension, or embolization is characterized by a predominantly motor deficit, with or without loss of pain and temperature sensation, but with sparing of vibration and joint sensations, which are transmitted in the posterior columns. D7 intercostal artery d7 radicular artery aorta spinal cord c3 radicular artery vertebral artery pial plexus radicular artery anterior spinal artery anterior nerve root anterior sulcus sulcal arteries fig. The anterior spinal artery supplies the anterior two thirds of the spinal cord, the remaining posterior third. Another branch of the vertebral artery is the single anterior spinal artery, which is supplied by both vertebral arteries. This symptom complex is so definite that it permits of an accurate clinical diagnosis, the symptoms varying somewhat with the level of the occlusion. The anterior spinal artery is formed rostrally from paired branches of the intracranial vertebral arteries that descend from the level of the medulla fig.
Anterior spinal artery syndrome the most common clinical presentation of a spinal cord infarction is anterior spinal artery asa syndrome 1,6,10. The two vertebral arteries one of which is usually bigger than the other anastamose in the midline to form a single anterior spinal artery at the level of the foramen magnum. Anterior spinal artery radiology reference article. Anterior spinal artery syndrome definition of anterior. The anterior spinal artery may be duplicated in some regions which could explain the occurrence of unilateral anterior infarction. Anterior spinal artery syndrome or becks syndrome or anterior cord syndrome is a rare neurovascular condition characterized by sudden ischemia with damage to the anterior 23rd of the spinal cord. Anterior spinal artery syndrome anterior spinal artery syndrome is a descriptor in the national library of medicines controlled vocabulary thesaurus, mesh medical subject headings. This artery is joined at different levels by anterior radiculomedullary arteries, which are branches of. Acute spinal cord ischemia syndrome represents only 58% of acute myelopathies 4,5 and anterior spinal artery in the region of the lumbar enlargement t9 to the conus medullaris is, as at the cervical enlargement, richly supplied, deriving its blood supply predominantly from a single large 1. Please practice handwashing and social distancing, and. Anterior spinal artery syndrome article about anterior. Anterior spinal cord syndrome comprises ischemia or infarction of the spinal cord in the distribution of the anterior spinal artery, which supplies the ventral twothirds of the spinal cord. Anterior spinal artery syndrome after aortic surgery in a. Spiller who described it 1909, however preobranshenski was the first to describe asas in 1904.
In adults, where it is observed most frequently after resection of thoracoabdominal aortic aneurysms, spinal magnetic resonance imaging is considered the firstline investigation to confirm the clinical diagnosis. But no case of reversible anterior spinal artery syndrome after balloon kyphoplasty is to be found in the literature as yet. The most common causes are arteriosclerosis, dissection of the. Siewe 1 department of orthopedics and trauma surgery, zks bmbf kn, university hospital of cologne. The anterior portion of the spinal cord is supplied by the anterior spinal artery.
Anterior spinal artery infarction paralysis below the level of the lesion, with loss of pain and temperature sensation below the level of the lesion and relative sparing of touch, vibration, and position sense. Spinal cord ischemia with paraplegia is rarely reported after segmental vessel ligation and if at all, after anterior thoracolumbar spinal surgery 1821. Thus, the vertebral arteries are very important, as they serve as the primary source of blood to the brain and the spinal cord. The anterior spinal artery syndrome was first described by spiller 1 in a case of thrombosis of this artery. Learn brainstem syndromes spinal with free interactive flashcards. It begins at the foramen magnum where branches of the two vertebral arteries exit, merge, and descend along the anterior spinal cord. The diagnosis usually is made on the basis of clinical findings because the cause of the syndrome remains obscure in most cases 2. Asas is thrombosis ventral to the spinal cord causing blockage of the anterior spinal artery asa and an infarction of the areas supplied. Choose from 500 different sets of brainstem syndromes spinal flashcards on quizlet. Anterior spinal artery article about anterior spinal. Descriptors are arranged in a hierarchical structure, which enables searching at various levels of specificity. The anterior spinal artery of adamkiewicz which supplies this region of the spinal cord is susceptible to occlusion in the midlumbar region as the radicular artery supplying it is an end artery with no collateral circulation.
Anterior spinal cord syndrome acs is a lesion affecting the anterior twothirds of the spinal cord with loss of motor control below the lesion with intact crude sensation 1, 2. The anterior spinal artery gives unilateral alternating branches sulcal arteries. Atypical anterior spinal artery infarction due to left. Objective to describe the polysomnographic findings in a patient with cervical asa syndrome complicated by a sleep breathing disorder. The authors report two cases of delayed postoperative anterior spinal artery syndrome asas following posterior correction with cotrel dubousset cd instrumentation for adolescent idiopathic scoliosis.
A true acs results from a vascular lesion at the anterior spinal artery asa resulting in ischemic injury to the respective area of. A sagittal t1weighted mr image of the cervical spine on admission shows no enhancement of the lesion. Anterior spinal artery syndrome is rare in children. Anterior spinal artery syndrome asas or spillers syndrome is named for william g. A sagittal t2weighted mr image of the cervical spine on admission shows high signal intensity lesion extending from bony level of c5 to upper part of. These two arteries fuse to form a single anterior spinal artery that overlies the anterior longitudinal fissure of the spinal cord. Spinal cord infarction secondary to occlusion of the anterior spinal artery.
Injury to the vascular supply to the lower spinal cord can lead to anterior spinal artery syndrome. Consistent with its functional neuroanatomy, an asa infarct typically presents as loss of motor function and paintemperature sensation, with relative sparing of proprioception and vibratory. The sulcal arteries supply the anterior twothirds of the spinal cord at any crosssectional level. Syndrome pop culture when innocent heroworship goes unrequited, the consequences can be dire for both the admirer and the admired. In human anatomy, the anterior spinal artery is the artery that supplies the anterior portion of the spinal cord. Spinal cord infarction following elective abdominal aortic aneurysm repair is a severe and catastrophic complication. Unlike the vertebral arteries, the basilar artery is an unpaired artery, which means that occlusion of the basilar artery can lead.
Common etiologies include mediastinal surgeries 1 2, diabetes with atherosclerosis 3, diseases of the aorta 4, hematological. The cause of the infarction can be either iatrogenic or secondary to diseases. Mechanisms and prevention of anterior spinal artery. It is reinforced by several contributory arteries, especially the artery of adamkiewicz.
Sulcal arteries are penetrating branches from the anterior spinal artery and extend posteriorly through the anterior median fissure of the spinal cord. Background anterior spinal artery asa syndrome results in motor palsy and dissociated sensory loss below the level of the lesion, accompanied by bladder dysfunction. Successive sulcal arteries generally alternate in their distribution to the left or right side of the spinal cord but not both 1,2. A true acs results from a vascular lesion at the anterior spinal artery asa resulting in ischemic injury to the respective area of the spinal cord. Pdf thrombolysis in anterior spinal artery syndrome. Anterior spinal artery syndrome associated with severe. Pdf anterior spinal artery syndrome associated with. Anterior spinal artery syndrome associated with severe stenosis of the vertebral artery article pdf available in american journal of neuroradiology 197. Anterior spinal artery syndrome asas is often a devastating spinal stroke occurring when the anterior spinal artery or one of its supplying anterior medullary arteries are occluded. Incredibles wannabe sidekick turned bad guy, from the incredibles 2004. Anterior spinal artery syndrome and its natural history.
Sensory pathways were continuously monitored from skin incision to awakening. Anterior spinal artery syndrome asas is a very rare condition which occurs following infarction of the anterior twothird of the spinal cord supplied by the anterior spinal artery. Anterior spinal artery an overview sciencedirect topics. Pdf anterior spinal artery syndrome following abdominal.
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