Why does it occur
The spinal cord is supplied with blood by the anterior and two posterior spinal arteries, which receive their supply from the branches of the aorta. There are few such feeding vessels, so turning off one of them immediately deprives a significant area of blood flow. The most common cause is diseases of the aorta: atherosclerosis, dissection, aneurysm, as well as operations and interventions on it. Other causes are thrombosis and embolism, a sharp and prolonged drop in blood pressure, compression of blood vessels by a herniated disc or tumor, vasculitis, and spinal injuries. Less common is hemorrhage into the spinal cord or its membranes.
- Diseases and operations on the aorta
- Thrombosis and embolism of the spinal arteries
- A sharp and prolonged decrease in pressure
- Compression of blood vessels by a herniated disc or tumor
- Vasculitis and blood clotting disorders
- Spinal injuries
- Hemorrhage into the spinal cord
How it manifests itself
The onset is usually sudden. The first symptom is often a sharp pain in the back or neck, sometimes irritating. Within minutes or hours, weakness develops in the legs, and if the cervical region is affected, in the arms. A characteristic feature of ischemia of the anterior spinal artery is that sensitivity to pain and temperature is lost, but the sensation of touch and body position is preserved. The functioning of the pelvic organs is almost always disrupted: urinary retention or incontinence occurs. Pressure may drop and sweating disorders may appear below the level of the lesion.
- Sharp pain in the back or neck at the beginning
- Weakness in the legs and sometimes in the arms
- Loss of pain and temperature sensitivity
- Preservation of the sensation of touch in the typical version
- Urinary retention or incontinence
- Decreased muscle tone in the acute period
How is this different from other causes of leg weakness?
A similar picture is given by compression of the spinal cord by a herniated disc, tumor or hematoma, acute inflammatory myelitis, Guillain-Barré syndrome and exacerbation of multiple sclerosis. It is impossible to distinguish them by complaints, and treatment tactics are fundamentally different: in case of compression, urgent surgery is required, in case of inflammation, anti-inflammatory therapy is required. That is why the main rule is simple: if there is sudden weakness in the legs with difficulty urinating, emergency hospitalization and an MRI are needed, rather than waiting and taking painkillers at home.
- Compression from a disc herniation or tumor—surgery needed
- Acute myelitis - inflammatory nature
- Guillain-Barre syndrome - ascending weakness
- Exacerbation of multiple sclerosis
- Distinction is possible only by MRI
Diagnostics
The main method is magnetic resonance imaging of the spine and spinal cord, if possible with modes that reveal fresh ischemia; in the first hours, changes may not be noticeable, so the study is sometimes repeated. At the same time, compression, inflammation and hemorrhage are excluded. Be sure to evaluate the condition of the aorta using computed tomography with contrast, especially for back and abdominal pain. Blood tests, coagulation parameters, ECG are prescribed, and if inflammation is suspected, a cerebrospinal fluid test is performed. All this is done in a hospital setting.
- Urgent MRI of the spine and spinal cord
- Repeated MRI with a normal picture in the first hours
- CT scan of the aorta with contrast
- Blood tests and coagulation indicators
- ECG and cardiac assessment
- Cerebrospinal fluid examination according to indications
Treatment and recovery
Treatment is carried out in a hospital. Maintain sufficient blood pressure to improve blood flow to the spinal cord, provide oxygen and monitor breathing when the level of injury is high. The cause is eliminated: in case of problems with the aorta, vascular surgeons are involved, in case of compression, surgery is performed, in case of inflammation, appropriate therapy is prescribed. From the first days, prevention of bedsores and thrombosis, care of the bladder and intestines are important. Rehabilitation begins early and continues for months: it determines how much function can be restored.
- Hospitalization and pressure maintenance
- Treatment of the cause: aorta, compression, inflammation
- Prevention of thrombosis and bedsores
- Bladder and bowel care
- Early physical therapy and verticalization
- Long-term rehabilitation with a physical therapist
- Controlling risk factors to prevent recurrences