Concomitant spinal cord and vertebral body infarction is highly associated with aortic pathology: a clinical and magnetic resonance imaging study

Abstract

The purpose of this article is to investigate the relationship between clinical features and imaging characteristics of spinal cord infarction (SCI). Twenty patients (11 women/9 men) were diagnosed at the Chang Gung Memorial Hospital between March 1993 and March 2007. Data of clinical features, possible causes and imaging findings were collected and analyzed retrospectively. Their average age was 56.6 +/- 15.5 years. Possible causes of SCI were found in 16 patients (80%), including 8 (40%) who had a high risk of atherosclerosis, 5 (25%) who had aortic diseases, and 3 (15%) who had adjacent spinal diseases; the other 4 (20%) were cryptogenic. Seven patients had concomitant SCI and vertebral body infarctions, and four of them had aortic diseases. Most of the vertebral body infarctions were seen in the thoracolumbar regions (p = 0.008, chi(2) test) and were adjacent to their cord lesions. Twelve patients (60%) had poor outcomes (mortality, unable to walk, or able to walk with two aids). Younger patients (<or=55 year-old) with long cord lesions (greater than or equal to three vertebral segments) had poorer outcomes than older patients with short cord lesions. Vertebral abnormalities are not uncommon, but easily overlooked in SCI. Furthermore, concomitant SCI and vertebral body infarctions were usually located at the thoracolumbar regions, and highly associated with patients with aortic diseases (p = 0.03, chi(2) test). An understanding of the spinal cord and vertebral vascular supply greatly benefits in early diagnosis, etiological illumination, and prognostic prediction of SCI.

Recent advances in spinal cord neurology

“…The clinical and imaging features in spinal cord ischemia are shown to be frequently connected with aortic disease and associated with a vertebral body infarction [6]. Concomitant spinal cord and vertebral body infarctions are frequently located in the thoracolumbar region.…”

Spinal tuberculosis paraplegia associated with anterior spinal artery infarction: a very rare presentation

“…[6] A finding of vertebral body infarction contiguous to a cord signal abnormality on MRI is a definite indicator of ischemia and a useful confirmatory sign if present; however, this is established in only 4 to 35 percent of patients, and its absence does not exclude spinal cord infarction. [7] We believe this patient suffered from an infraction of the spinal cord because of the typical clinical features on presentation, absence of cord compressions, and exclusion of other known neurological diseases. A typical loss of motor neuron function with dissociated sensory impairment below the level of the lesion pointed to anterior spinal artery syndrome [8] as the result of an infraction occurring in the region supplied by this artery.…”

Clinical Core Symptoms of Posterior Spinal Artery Ischemia

“…Frequently, patients are reported to experience pain and the location of pain is related to the spinal level of ischemia [4]. Since proximal segmental arteries feed not only the spinal arteries but also the vertebral body, embolism of segmental arteries might lead to painful bone marrow infarction.…”

“…Because of the specific anatomy of blood vessels to the spinal cord, infarctions occur more frequently in the territory of the single anterior spinal artery in the lower cervical and upper lumbar region [2,4]. The posterior part of the spinal cord is supplied by two posterior spinal arteries.…”

“…The etiology of ischemia cannot always be identified, but the main causes identified are embolism, aortic disease such as arteriosclerosis, aortic aneurysm or dissection [4], procoagulant states, vasculitis and infection [6]. …”