Spinal Cord Infarction: Causes, Symptoms & Treatment

A spinal cord infarction is due to insufficient blood flow and a resulting undersupply of oxygen and glucose. The result is paralysis, pain, and impaired temperature and pain sensation. Treatment is symptomatic or manual therapy.

What is a spinal cord infarction?

An insufficient pathologic blood supply due to constriction or occlusion results in an undersupply of oxygen and glucose because there is no longer an adequate supply of arterial blood. This undersupply leads in the result to a so-called spinal cord infarction, also called ischemic myelopathy. It should be kept in mind that due to the partially low collateral supply of the anterior spinal artery, certain segments in the spinal cord are particularly susceptible to ischemia. The susceptibility refers to the 2nd and 4th collateral segments. More often than by intrinsic disturbances of the spinal arteries, spinal cord infarction occurs as a result of damage to an extravertebral, or feeding, artery or to the aorta. In short, if blood flow to the spinal cord is stopped by a blocked vessel or blood clot, the dreaded spinal shock occurs. Even the slightest suspicion of a spinal cord infarction must be treated immediately by neurologists or neurosurgeons. The consequences of this disease can have a negative impact on the rest of the patient’s life. In the worst case, spinal cord infarction is fatal.

Causes

Aortic dissection as well as polyarteritis nodosa may be responsible for spinal cord infarction. Diabetics are also commonly affected by neurologic deficits caused by an infarction in the spinal cord. Elderly people are also at risk. In younger years, this symptomatology occurs rather rarely. Arteriosclerosis or an embolism can restrict the blood supply to the ventral (abdominal) anterior spinal artery and the dorsal (back) posterior spinal artery. Because they are paired, the cause is less commonly found here. Fibrocartilaginous emboli from the intervertebral discs are considered special and tend to be found in young and athletic patients. However, pregnant women may also be affected. Not to be forgotten are the vascular malformations such as an arterio-venous dural fistula. It, too, can lead to infarction in the spinal canal. Much more frequently, spinal cord infarction occurs due to obstructions of the arteries caused by tumors, aortic aneurysms, or aortic dissections. Involvement of the spinal vessels in association with vasculitis should also be considered as a cause. Rather unusually, thrombosis and polyarteritis (vasculitis of the medium-sized arteries) are considered to be precipitating factors.

Symptoms, complaints, and signs

Anyone about to suffer a spinal cord infarction (spinal anterior syndrome) feels a sudden pain in the back with a ring-like radiating tightness. This is followed within a few minutes not only by sensory deficits. Rather, there are also segmental paralysis symptoms on both sides. In addition, the perception of pain and temperature is significantly disturbed. These symptoms are based on a missing or insufficient blood supply, which leads to the spinal cord no longer being able to transmit signals from the brain. In contrast, the sense of position and vibration, as well as the ability to perceive light touch, are relatively well preserved. If the infarction is small and affects only the tissue farthest from the spinal cord, it may also be a central spinal cord syndrome. Neurological deficits may then resolve within the next few days. Because of the variable location of the great radial artery, such infarction is known and feared as a complication of thoracic aortic surgery.

Diagnosis and Course of the Disease

Diagnosis is made by MRI examination. This, in conjunction with a cerebrospinal fluid (CSF) examination, can rule out other conditions with a similar course of symptoms. These include acute paraplegic myelitis, spinal cord compression, and various demyelinating diseases. Diagnosis by MRI also allows detection of lesions in most cases. The subsequent course depends largely on where the spinal cord infarction occurred. The further up it runs to the cervical medulla, the more bodily functions are affected and fail.The clinical manifestations include, always depending on the arteries affected, the “spinal artery-antrior syndrome” as well as the “spinal artery-posterior syndrome”. This is a combination of sensory disturbances, pain, and paralysis, usually occurring suddenly.

Complications

Spinal cord infarction is an emergency and is a complication of various vascular diseases such as aortic aneurysms, atherosclerosis, or others. If treatment is started in time, there is a good chance of recovery. This is always possible if the spinal cord is not yet completely damaged. Otherwise, permanent damage up to paraplegia occurs. Treatment is based on the underlying disease. Among other things, emergency surgery must be performed on the injured or blocked artery to stop bleeding or to correct the undersupply of blood in the case of ischemia. Symptomatic treatment then follows. The healing process takes place depending on the damage to the spinal cord. In approximately 70 percent of affected patients, there is complete healing. In about 30 percent of cases, the spinal cord is already so severely damaged that complete healing is no longer possible. The course of a spinal cord infarction also depends on the blood vessels affected. For example, the so-called spinal artery anterior syndrome is characterized by a difficult and complicated course. This syndrome is caused by a circulatory disturbance of the anterior spinal artery. Spinal shock occurs with incomplete paralysis of both legs, which lasts for several months. The pain and numbness are usually girdling. Furthermore, rectal and bladder disorders occur. Complications include severe pressure ulcers of the skin, which can lead to necrosis.

When should you go to the doctor?

The dreaded ischemic myelopathy can cause paralysis, significantly disturbed sensation of temperature and pain, and severe pain radiating from the back in an annular pattern. Since the cause is a sudden disturbance of blood flow to the spinal cord, there is acute danger. A visit to the doctor should be made immediately. If the spinal cord infarction occurs as a result of thoracic surgery, the patient is already in medical hands. Spinal shock, which can result from a blocked vessel, requires immediate treatment. If left untreated, it can have dramatic consequences, reducing quality of life throughout life or leading to death. The patient should be immediately seen by a neurologist or transferred to neurosurgery. Spinal cord infarction is a potentially fatal event that does not allow for delay because of the severe consequences. Spinal cord infarction – also known as spinal anterior syndrome – is typically characterized by severe back pain accompanied by a ring-like sensation of tightness. Immediately afterward, there is loss of sensation and bilateral paralysis. In addition, significant perceptual disturbance in pain or temperature may be diagnosed. The emergency physician should be notified immediately because the damaged spinal cord can no longer transmit signals. A distinction should be made between small and large spinal cord infarcts. In central spinal cord syndrome, neurologic deficits may resolve after a few days.

Treatment and therapy

The best therapeutic outcome naturally occurs when the spinal cord has not been completely destroyed and has only ceased to function. Regeneration can be achieved with targeted exercise therapy lasting several weeks. If an aortic dissection or polyartritis nodosa is known to be the trigger, the first priority is to treat these secondary conditions. Symptomatic treatment is the order of the day in most cases. If MRI reveals space-occupying lesions, surgical decompression must be initiated immediately. Subsequent treatment is symptomatic in most cases. However, it can also be based on the treatment measures that are usual in a paraplegic lesion. The primary goal is to ensure that vital functions are still present or to restore them. Experienced and specialized physiotherapists and occupational therapists are the competent contacts for this. Special physiotherapeutic exercises are used to maintain and, if necessary, improve any remaining mobility.Also the TENS treatment as well as foot reflex zone treatments have proven themselves. In this way, the dreaded muscle shortening and stiffening can be counteracted. It is not uncommon for patients to sit in a wheelchair at the beginning of such therapy or to require aids such as one or two walking sticks or a rollator. This is accompanied by neurological check-ups at regular intervals. These are necessary to prevent secondary damage as far as possible. Subsequently, it is important to treat the cause.

Prevention

The most important preventive measure to avoid spinal cord infarction is probably stabilization of the back muscles. This can be done through age-appropriate sports that are done continuously. Swimming, floor exercises (gymnastics) and light adapted strength exercises are recommended in this context.

Aftercare

Affected patients must undergo rehabilitation measures immediately after a spinal cord infarction. With specialized therapy, most people can return to moving as they did before the spinal cord infarction. Affected individuals should undergo regular physical therapy and occupational therapy exercises at home for improvement. In addition, any kind of stress and strain should be avoided. Affected patients need sufficient rest and protection, especially in the first few weeks. Medications that can be taken can accelerate the healing process. Globulis and pain-relieving and soothing teas are recommended. In addition, the diet should be changed after the spinal cord infarction and thus adapted. Affected people should eat a very healthy diet and eat a lot of fruits and vegetables. In addition, the diet should be very rich in vitamins. If affected persons are addicted to alcohol or cigarettes, it is recommended to contact an addiction counseling service. Consuming such substances should be refrained from, otherwise spinal cord infarction may occur again. If the spinal cord infarction had to be operated, affected persons are dependent on a wheelchair or crutches afterwards. In this case, the help and support of family and relatives is needed because affected people can hardly move. In addition, help from relatives is also needed for everyday tasks.

This is what you can do yourself

After a spinal cord infarction, rehabilitation measures must be started early. Appropriate therapy will help the muscles and often allow patients to move as they did before. Part of the treatment are physiotherapeutic and ergotherapeutic exercises, which the affected persons can perform themselves at home. At the same time, however, sufficient rest should be ensured. Especially in the first days and weeks after an infarction, the back needs rest. The patient can take painkillers from homeopathy or the household, and thereby promote recovery. Globules have proven effective, but also pain-relieving teas with the extracts of chamomile or lemon balm. Furthermore, the diet should be adjusted after a spinal cord infarction. The usually causal circulatory disturbance of the spinal cord is due to a one-sided diet. Accordingly, after the medical emergency, a balanced diet with plenty of fruits and vegetables is important. Smokers and alcoholics are best to contact addiction counseling. The triggers must be eliminated, because otherwise it can lead to renewed infarctions. After spinal cord surgery, normal movement is usually not possible. The patient is dependent on crutches or a wheelchair, which must be organized at an early stage. In addition, he needs the help of relatives and friends, who should be supportive during the difficult time. Which accompanying measures are useful in detail must be decided by the responsible physician.