Anterior Spinal Artery Syndrome due to Intervertebral Disc Herniation

Abstract

ObjectiveAnterior spinal artery syndrome (ASAS) has been rarely reported as a complication of intervertebral disc herniation (IVDH). Precipitation factors, presentation, evaluation, treatment strategy, and degrees of recovery have not yet been well documented.MethodsSystematic review was conducted according to PRISMA guidelines to review and summarize for the qualitative synthesis of the data from reported cases of anterior spinal artery syndrome due to intervertebral disc herniation from 1980 to February 2021.ResultsA total of 12 cases were reviewed, the median age was 48.5 years. Motor weakness with or without pain was the most frequent presenting symptom accompanying bowel or bladder incontinence (25%) or diminished pain and temperature sensation with spared dorsal column sensation. 40% of conservatively treated patients had complete recovery without any residual deficit. Whereas all patients who managed surgically regained fully functional status with shorter recovery intervals.ConclusionAbrupt onset of motor weakness is a potential warning symptom of spinal cord infarction, rarely attributed to ASA compression by a herniated disc. Moreover, an accompanying diminished pain and temperature sensation with spared dorsal column sensation is further intimation. Reestablishment of blood flow may bear a favorable outcome.

Fibrocartilaginous embolism: an under-recognised cause of young spinal stroke

“…Anterior spinal artery syndrome from arterial occlusion may rarely occur in the context of disc herniation and secondary canal stenosis. In such cases, where there is significant canal stenosis, angiography may help to identify cases with extrinsic compression of the spinal artery in which surgical decompression may be considered 21. In this case, however, CSF space was preserved at the level of disc prolapse.…”