Most SCI (spinal cord injuries) are caused by trauma to the vertebral column which affects the spinal cord’s ability to send and receive messages from the brain to the body’s systems that control sensory, motor and autonomic function below the level of injury.
Anterior cord syndrome (or Beck’s syndrome or anterior spinal artery syndrome) may also be caused by ischemic injury to the anterior aspect of spinal cord due to occlusion of the anterior spinal artery which mostly occurs as a consequence of non traumatic process, although it can also 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 such as due to a herniated disc, a neoplastic mass, posterior osteophyte, kyphoscoliosis. Traumatic etiologies include direct stab injuries to the spinal cord [1] or cervical flexion injuries.
The Anterior cord syndrome is the most common and most severe, as it affects the anterior portion of the spinal cord which controls motor function and the majority of sensation. [2] However, it is not in all cases that the leg (or lower extremities) are more affected than the upper extremities. Patients typically present with acute paraparesis or quadriparesis, depending on the level of the spinal cord involved. [3] Usually, the higher up the spinal cord the injury or lesion occurs (e.g. upper cervical segments C2 or C3), the more severe the affectations. In addition, neurological deficits will be observed in both upper and lower extremities (quadriparesis or quadriplegia). On the other hand, if the injury occurs much lower down the spinal cord, say in the lower lumbar or sacral segments, then the affectations are less severe and the neurological deficits will be observed more in the lower extremities than in the upper extremities (paraparesis or paraplegia).
The clinical presentation typically observed with anterior spinal cord syndrome is paralysis with loss of pain and temperature sensation below the level of the lesion and relative sparing of touch, vibration, and proprioception sense (because the posterior columns receive their primary blood supply from the posterior spinal arteries). [4]
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