Spinal Cord Infarction

This chapter discusses spinal cord infarctions, which are rare but with devastating consequences. It is associated with surgical procedures that compromise oxygen supply to the spinal cord, arteriosclerosis, embolism of the spinal cord circulation, or compression of blood vessels of the spinal cord. The most common of spinal neurovascular syndromes is the anterior spinal artery syndrome, caused by infarction in the anterior two-thirds of the cord. This syndrome spares the dorsal columns as the posterior one-third of the spinal cord is supplied by a pair of posterior spinal arteries. It is characterized by complete motor paralysis below the level of the lesion; loss of pain and temperature sensation with sparing of proprioception and vibratory sensation; and autonomic dysfunction, such as hypotension, sexual, and bowel and bladder dysfunction. MRI imaging, biochemical and immunological studies from cerebrospinal fluid and blood, and spinal angiography can be considered to confirm the diagnosis and delineate the cause. Treatments are directed at managing motor paralysis and spasticity, sensory dysfunction and pain, and autonomic dysfunction that includes neurogenic bladder and autonomic dysreflexia. Cervical and thoracic spinal cord injury affects respiratory muscles, causing pneumonia, in addition to autonomic dysreflexia. Preventive measures during abdominal aorta aneurysm surgery include neuromonitoring of the spinal cord, spinal fluid drainage, induced hypothermia, and use of pharmacological adjuncts such as intrathecal papaverine. Precautions in using particulate steroids for transforaminal epidural injection in pain management may help reduce the risk of articular embolism in the spinal cord or brainstem.