Anterior spinal cord syndrome

What it is

Anterior cord syndrome is one of the incomplete spinal cord syndromes. The lesion sits at the front of the cord, so the affected spinal tracts are the corticospinal tracts and the spinothalamic tracts, while the dorsal column is spared. The anterior spinal artery lies at the front of the cord, and the posterior spinal arteries lie at the back, next to the dorsal column. That is why the two senses of the dorsal column, vibration and proprioception, stay intact when the front of the cord is lost. Set against it, posterior cord syndrome comes from occlusion of the posterior spinal artery or from multiple sclerosis; there the posterior columns are the affected tracts, and the bilateral loss below the level of the lesion is of proprioception, vibration and touch sensation.

Causes and risk

There are two causes:

• Occlusion of the anterior spinal artery.
• Trauma, for example a burst fracture of a vertebra or a penetrating injury.

The thoracic segment of the cord, at T4-6 and in its anterior 2/3, is the most vulnerable to an ischemic lesion, because it is a watershed area. The large additional feeder artery of that region, the anterior medullary artery of Adamkiewicz, arises from the aorta only in the lower thoracic (T8) or upper lumbar region.