Anterior Spinal Artery Syndrome in a Patient with Cervical Spondylosis Demonstrated by CT Angiography

Abstract

A few published reports have described anterior spinal artery syndrome (ASAS) with cervical spondylosis based on clinical presentation and/or MRI study, but no photographs of anterior spinal arteries were provided in these studies. Here we present a case of ASAS with cervical spondylosis in a CT angiography (CTA) study. A previously healthy 31‐year‐old man was diagnosed with acute ASAS with cervical spondylosis. Neurological examination revealed four‐limb weakness predominant in the distal part of the upper limbs and superficial sensory impairment below the cervical region. T2‐weighted images on MRI showed an area of hyperintensity in the gray matter of the cervical cord from C3 to C5 with a disc herniation at the C4,5 vertebral level. CTA demonstrated that ASA was occluded at level C4,5, which coincided with the location of disc herniation. Anterior spinal cord decompression and fusions were performed. The patient tolerated the procedure well and had complete resolution of his exertionally dependent myelopathic symptoms 1 week later. In conclusion, although ASAS with cervical spondylosis is rare, it can be diagnosed based on clinical symptoms and MRI and identified by CTA of ASA. A good neurological prognosis is anticipated after anterior spinal cord decompression and fusion is performed if disc herniation is responsible for ASA occlusion.

Anterior Spinal Artery Syndrome due to Intervertebral Disc Herniation

“…Considering true arterial occlusion, a typical posterolaterally displaced disc is more likely to compress the radicular artery. However, direct compression to ASA has also been reported, should be considered as more severe than occluding its feeding branch [5], [11], [12], [14], [15]. Therefore, a probability of ASA interruption should be considered in a spondylotic patient with ventral cord syndrome.…”

Total spinal anesthesia caused by lidocaine during unilateral percutaneous vertebroplasty performed under local anesthesia: A case report

“…Symptoms of our patient were inconsistent. It is generally caused by occlusion or hypoperfusion of the anterior spinal artery[ 18 ]. It might be caused by iatrogenic reasons, causing irreversible damage.…”

The Role of Folate Deficiency as a Potential Risk Factor for Nontraumatic Anterior Spinal Artery Syndrome in an Adolescent Girl

“…Spinal cord infarction (SCI) is rare, accounting for approximately 0.3% to 1% of ischemic strokes and constituting only 1% to 2% of all neurological vascular emergencies [ 1 ]. Anterior spinal artery syndrome (ASAS) is an exceptionally rare acute ischemic spinal cord infarction, commonly presenting with an acute and painful myelopathy, resulting from the occlusion or hypoperfusion of the anterior spinal artery’s (ASA) blood supply, which consequentially impedes the circulation of the anterior two-thirds of the spinal cord [ 2 ]. The typical neurological symptoms of ASAS include acute loss of pain/temperature sensation and motor function below the affected levels of the ischemic spinal cord, which is often accompanied by neurogenic bowel/bladder dysfunction.…”

“…These flexion–extension injuries, especially at the cervical spinal cord, may induce a transient occlusion of the vertebral arteries or the ASA with the result of an SCI [ 3 ]. While some cases of ASAS could be attributed to a vertebral fracture [ 4 ], spondylosis [ 2 , 5 , 6 ], and/or some minor trauma [ 4 ] before ASAS onset, a large proportion of cases may not have a definite cause. Although a few studies have tried to investigate the etiology or risk factors of ASAS, the identification of nontraumatic ASAS etiology in children remains a challenging topic needing further investigation since a large population of these patients remain idiopathic even after an extensive workup [ 7 ].…”