Anterior spinal artery syndrome caused by thoracic disc herniation. (July 2020)

• Record Type: Journal Article
• Authors: Santillan, Alejandro; Goldberg, Jacob L.; Carnevale, Joseph A.; Kirnaz, Sertac; Hartl, Roger; Knopman, Jared
• Is Part Of: Journal of clinical neuroscience. Volume 77(2020)
• Page Start: 211
• Page End: 212
• Publication Date: 2020-07
• Subjects: Anterior spinal artery -- Thoracic disc herniation -- Lumbar interbody fusion -- Angiography; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.05.040
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Anterior spinal artery syndrome caused by disc herniation is rarely reported as a result the upfront management remains controversial. Anterior spinal artery (ASA) ischemia classically causes dysfunction of the anterior two-thirds of the spinal cord known as ASA syndrome. We report angiogram proven ASA compression from a herniated disc managed with upfront surgery with excellent clinical outcome. Abstract: We present a case of a midline thoracic disc herniation causing acute anterior spinal artery (ASA) syndrome successfully managed surgically. A 54-year-old female with no significant past medical history presented with sudden onset severe back pain followed by rapidly evolving paraparesis with urinary and bowel incontinence. Her neurological exam was consistent with ASA syndrome. An MRI revealed T2 signal change in the thoracic spinal cord and midline disc herniation at the level of T8/T9. Spinal angiography revealed an ASA arising the right T11 segmental artery with no flow towards the T8/T9 region. The patient underwent a T8/T9 discectomy with a lateral interbody fusion that resulted in dramatic clinical improvement. A postoperative angiogram confirmed improvement of flow in the ASA. This is the first report of an angiographically confirmed symptomatic ASA syndrome caused by a thoracic disc herniation successfully managed with up-front surgery.