Ventral cord syndrome

Ventral cord syndrome (also known as anterior cord syndrome) is one of the incomplete cord syndromes and affects the anterior parts of the cord resulting in a pattern of neurological dysfunction dominated by motor paralysis and loss of pain, temperature and autonomic function. Anterior spinal artery ischaemia is the most common cause. 

Terminology

Ventral cord syndrome encompasses all causes of damage to the anterior spinal cord regardless of aetiology (see below). In contrast, anterioranterior spinal artery syndrome, also known as Beck's syndrome, denotes a ventral cord syndrome specifically due to ischaemia/infarction of the anterior two-thirds of the spinal cord due to involvement of the anterior spinal artery. 

Clinical presentation

Patient presents withInvolvement of the following featuresanterior half to two-thirds of the spinal cord results in a predictable pattern of neurological impairment consisting of:

• complete motor paralysis below the level of the lesion due to involvement of the anterior horn cells and corticospinal tracts
• loss of pain and temperature at and below the level of injury due to involvement of spinothalamic tract
• intact 2-point discrimination, proprioception and vibratory senses due to intact posterior columntracts
• autonomic dysfunction: orthostatic hypotension due to involvement of lateral horn cells⁶
• bladder and bowel dysfunction and sexual dysfunction may arise depending on the level of the lesion

Pathology

AnteriorVentral cord syndrome is caused by ischaemic injury toa variety of processes, the anterior aspect of spinal cordmost common one being ischaemia due to occlusion of anterior spinal artery, which most commonly occurs asin turn is the result of a consequencenumber of non-traumaticunderlying processes. As such, although it may be traumatic. The anterior two-thirdsthe list of thecausative pathologies is very similar to that of acute spinal cord contains corticospinal and spinothalamic tracts, which are affected in thisischaemia syndrome.

Causes of anteriorventral cord syndrome include ^1-5:

• ischaemia/infarction (anterior spinal artery occlusion include:syndrome)
  • atherosclerosis atherosclerotic thromboembolism
  • aortic pathology
    • aortic aneurysm
    • aortic thrombosis
    • aortic dissection
    • aortic surgery/intervention
  • anterior spinal artery pathology
    • penetrating trauma (e.g. stabbing)
    • arterial dissection (e.g. catheter angiography)
    • fibrocartilaginous embolism
• external compression/damage of the anterior spinal cord
  • herniated disc
  • neoplastic massspinal tumour (e.g. intrathecal extramedullary)
  • posterior osteophyteepidural collections (e.g. epidural haematoma and epidural abscess)
  • kyphoscoliosis
• trauma
  • vertebral body fractures
  • trauma: direct stab injuries

Radiographic features

For a description of the imaging features please refer to acute spinal cord ischaemia syndrome.

Treatment and prognosis

Prognosis of anterior cord syndrome is worst among all other spinal cord injury syndromes⁵. 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.