The disorder known as anterior cord syndrome affects the spinal cord. An injury to the spinal cord normally affects only the area below the injury, but it can influence the whole body through blood pressure and the autonomic nervous system, which governs unconscious body functions.
The term ‘anterior’ refers to the affected part of the chord; in this case, the side of the cord that faces the front of the body. It’s an ischemic disorder, which means it results from the insufficient “feeding” of the spinal cord with blood and oxygen, and nutrients, leading to tissue injury.
The terms “Anterior spinal artery syndrome” (ASAS) and “ventral cord syndrome” are both used to describe “anterior cord syndrome” (VCS).
Definition:
ASAS (Anterior Spinal Artery Syndrome) or Anterior Cord Syndrome is an incomplete spinal cord injury (SCI) that is often caused by flexion injuries to the neck that cut off blood flow to the first two-thirds of the spinal cord and/or its blood supply from the anterior spinal artery. Pain and temperature sensations are impaired, although vibratory and proprioceptive feelings remain intact. Impairments in motor function are visible both at and under the site of the injury.
Anterior Cord Syndrome Symptoms
Anterior cord syndrome is a disorder with a rapid and unexpected onset. People report sitting down and abruptly losing all sensation or movement in their legs without any warning. This condition affects the body on both the left and right sides.
Muscle weakness and loss of motor control are two of the most prominent symptoms. People with anterior spinal cord syndrome also lose some of their ability to feel pain or heat, but they usually keep their normal sense of touch. Anterior cord injury seldom affects proprioception, which allows people to intuitively comprehend their body’s position, placement, and movement. Some individuals lose control of their intestines and bladder due to a loss of muscle tone and feeling.
The clinical manifestations of ASA syndrome vary depending on the degree of ischemia. There are variable degrees of muscle weakening and dissociated sensory loss: pain feeling is reduced or eliminated, but proprioception is largely or entirely preserved. Pyramidal and spinothalamic circuits in the spinal cord are very close to one another, thus when the motor function is compromised, so is sensory perception and vice versa.
Other symptoms of the illness often vary depending on the site of the injury. Autonomic dysreflexia, movement, and sexual problems, neuropathic pain, and problems with the bladder and bowel are all possible.
Anterior Cord Syndrome Causes
Anterior spinal artery ischemia is the underlying cause of this anterior cord syndrome. Anterior cord syndrome mostly results from a wide variety of conditions and interventions that reduce blood supply to the chord itself.
Surgery to repair a thoracic or thoracoabdominal aortic aneurysm is the most prevalent iatrogenic cause of anterior cord syndrome. During surgery, ischemia of the spinal cord is caused by low blood pressure, cross-clamping of the aorta, increased pressure in the spinal canal and blocking of the arteries that feed the spinal cord. Occlusion of aortic branch vessels, including radicular arteries that feed the ASA, causes spinal cord ischemia in rare cases.
Other causes of hypotension include cardiac arrest, atherothrombotic illness, emboli, vasculitis, other disorders affecting blood arteries, sickle cell disease, other hypercoagulable conditions, intervertebral disc herniation, AV malformation, and cocaine usage.
Anterior Cord Syndrome Treatment
The majority of the time, treating this illness just focuses on symptom relief and avoid further consequences. It is important to address limitations in everyday activities, mobility, and sexual, bowel, and bladder function, both while the patient is hospitalized and after discharge. To improve their functional independence after being discharged, patients should be able to securely access and use the necessary adaptive equipment. It is also important to take into account the patient’s psychosocial function and engagement to boost the patient’s level of independence, improve their quality of life, and eventually improve their prognosis.
Aortic surgery is the most typical cause of anterior cord syndrome. The risk of spinal cord ischemia following aortic surgery is mitigated with the help of a predetermined strategy. It entails gradually raising the patient’s mean arterial pressure with the administration of vasopressor medicines and intravenous fluids to raise the intravascular volume and the systemic vascular resistance, respectively. The cerebrospinal fluid is also taken out with a lumbar drain. These procedures are meant to alleviate the pressure in the spinal canal and boost blood flow to the afflicted area of the spine by improving the vasculature.