Ventral cord syndrome

Anterior cord syndrome (also known as Beck's syndrome or anterior spinal artery syndrome) is a clinical subset of spinal cord injury syndromes, due to ischaemia/infarction of the anterior two-thirds of the spinal cord, typically sparing the posterior third.

Clinical presentation

Patient presents with the following features:

• complete motor paralysis below the level of the lesion due to involvement of the corticospinal tracts
• loss of pain and temperature at and below the level of injury due to involvement of lateral spinothalamic tract
• intact 2-point discrimination, proprioception and vibratory senses due to intact posterior column
• autonomic dysfunction: orthostatic hypotension
• bladder and bowel dysfunction and sexual dysfunction may arise depending on the level of the lesion

Pathology

Anterior cord syndrome is caused by ischaemic injury to the anterior aspect of spinal cord due to occlusion of anterior spinal artery, which most commonly occurs as a consequence of non-traumatic processes, although it may be traumatic. The anterior two-thirds of the spinal cord contains corticospinal and spinothalamic tracts, which are affected in this syndrome.

Causes of anterior spinal artery occlusion include:

• atherosclerosis 
• aortic pathology
  • aortic aneurysm
  • aortic thrombosis
  • aortic dissection
  • aortic surgery/intervention

• external compression
  • herniated disc
  • neoplastic mass
  • posterior osteophyte
  • kyphoscoliosis
• trauma: direct stab injuries

Treatment and prognosis

Prognosis of anterior cord syndrome is worst among all other spinal cord injury syndromes. It is associated with high mortality and poor functional outcome in terms of poor recovery of motor power and coordination.

Treatment is focused on treating the primary cause of anterior spinal artery insufficiency and general supportive treatment and care.

History and etymology

The anterior cord syndrome is thought to have been initially described Schneider in 1955 in the English literature ^ref although there are reports of this being described by K Beck in German literature in 1952 ⁴.