Pearl Nathaniel A., Weisbrod Luke J., Dubensky Laurence
Aventura Hospital and Medical Center
UNMC
Anterior cord syndrome is an incomplete spinal cord syndrome that predominantly affects the anterior two-thirds of the spinal cord, resulting in motor deficits and loss of sensory function in pain and temperature. The patient presentation varies depending on the portion of the spinal cord affected and the time to treatment. Other findings include back pain or autonomic dysfunction, such as hypotension, neurogenic bowel or bladder, and sexual dysfunction. The severity of motor dysfunction can vary, typically resulting in paraplegia or quadriplegia depending on how rostral the level of the spinal cord involved is. The syndrome is caused by ischemia within the anterior spinal artery (ASA), which supplies blood to the anterior two-thirds of the spinal cord. The ASA forms from the bilateral vertebral arteries at the foramen magnum. The ASA runs as an uninterrupted artery within the anterior median sulcus of the spinal cord to the conus medullaris. Radicular arteries enter the spinal canal through the intervertebral foramen and primarily supply the nerve roots; however, some anastomoses contribute to the ASA. The largest of these radicular arteries is the artery of Adamkiewicz, which most commonly arises off of a left intercostal artery between segments T9 to T12 but can vary anatomically. The ASA branches into small sulcal and penetrating arteries that enter the body of the spinal cord. The ASA supplies blood to the spinal cord's bilateral anterior and lateral horns and the bilateral spinothalamic tracts and corticospinal tracts. The anterior horns and corticospinal tracts control the somatic motor system from the neck to the feet. The lateral horns span levels T1 to L2 of the spinal cord and comprise the neuronal cell bodies of the sympathetic nervous system. The spinothalamic tracts relay pain, temperature, and sensory information. The anterior spinal artery, with a few radicular artery contributions, is the sole source of blood supply to these areas of the spinal cord via its sulcal and penetrating arteries. Ischemia of the ASA causes symptoms consistent with the dysfunction of these tracts. Since the ASA is formed from the more cephalad vertebral arteries and runs caudally, the more rostral the location of ischemia, the more widespread or severe the symptoms are. Since the lateral horns are located only between T1 to L2 of the spinal cord, autonomic symptoms are not always present if ischemia does not involve this region. Proprioception, vibratory sense, two-point discrimination, and fine touch are not affected in anterior cord syndrome and are carried by the dorsal column of the spinal cord, which is perfused by two posterior spinal arteries running in the posterior lateral sulci.
脊髓前动脉综合征是一种不完全性脊髓综合征，主要影响脊髓前三分之二，导致运动功能障碍以及痛觉和温度觉的感觉功能丧失。患者的表现因脊髓受累部位和治疗时间而异。其他表现包括背痛或自主神经功能障碍，如低血压、神经源性肠或膀胱功能障碍以及性功能障碍。运动功能障碍的严重程度各不相同，通常根据脊髓受累节段的位置高低导致截瘫或四肢瘫。该综合征由脊髓前动脉（ASA）缺血引起，脊髓前动脉为脊髓前三分之二供血。脊髓前动脉由枕骨大孔处的双侧椎动脉形成。脊髓前动脉在脊髓前正中沟内作为一条不间断的动脉延伸至脊髓圆锥。根动脉通过椎间孔进入椎管，主要为神经根供血；然而，一些吻合支为脊髓前动脉供血。其中最大的根动脉是Adamkiewicz动脉，它最常见于T9至T12节段之间的左侧肋间动脉发出，但解剖位置可能有所不同。脊髓前动脉分支为进入脊髓实质的小沟动脉和穿通动脉。脊髓前动脉为脊髓双侧的前角和侧角以及双侧脊髓丘脑束和皮质脊髓束供血。前角和皮质脊髓束控制从颈部到足部的躯体运动系统。侧角跨越脊髓的T1至L2节段，包含交感神经系统的神经元细胞体。脊髓丘脑束传递痛觉、温度觉和感觉信息。脊髓前动脉在少数根动脉的参与下，通过其沟动脉和穿通动脉成为脊髓这些区域唯一的血液供应来源。脊髓前动脉缺血导致与这些传导束功能障碍一致的症状。由于脊髓前动脉由较高位的椎动脉形成并向尾端走行，缺血位置越高，症状越广泛或严重。由于侧角仅位于脊髓的T1至L2节段之间，如果缺血不涉及该区域，则不一定会出现自主神经症状。本体感觉、振动觉、两点辨别觉和精细触觉在前脊髓综合征中不受影响，由脊髓后柱传导，脊髓后柱由在脊髓后外侧沟走行的两条脊髓后动脉供血。
