Blood Supply of the Spinal Cord

Question 1

Describe the blood supply of the spinal cord.

Answer 1

Anterior spinal artery (single)
Anterior 2/3rds of spinal cord
Motor area - anterior horn

Posterior spinal arteries (paired)
Posterior columns

Segmental arteries - 21 pairs

Question 2

In which layer around the spinal cord are the spinal arteries and veins located?

Answer 2

In between the arachnoid mater and pia mater

Question 3

What sort of pathologies can you get in the spinal arteries?

Answer 3

Anterior spinal artery occlusion is most common
Aetiology:
- Disease of the aorta - aneurysm, trauma, dissection
- Atherosclerosis
- Aortic surgery
- Vasculitis (GCA)
- Sickle cell disease
- Hypotension
- Cardiac emboli
- Disc herniation

Question 4

How does an anterior spinal artery occlusion present?

Answer 4

Acute (80% are painful
Fever is a red flag
- Acute bacterial meningitis
- Epidural/subdural abscess
- Granuloma
- Viral illness
95% are anterior spinal infarcts

Question 5

What is found on examination of a spinal blood supply injury?

Answer 5

Spinal shock initially
- Flaccid weakness
- Areflexic
- Anaesthesia
Loss of pain and temperature, but posterior column modalities preserved
Progresses to UMN signs with muscle atrophy/sensory level and sphincter disturbance

Question 6

What are some of the differential diagnosis’ of a spinal blood supply injury?

Answer 6

Mass lesion
- Tumour, abscess, granuloma, haematoma, herniated 
   disc
Intraspinal haemorrhage
Acute inflammation demyelinating polyneuropathy
- E.g. Guillain-Barre Syndrome
Demyelination, transverse myelitis
Sarcoid, TB, syphilis

Question 7

How is spinal cord blood supply injury managed?

Answer 7

Early identification of reversible causes
Treat cause
Manage vascular risk factors (where indicated)
Rehabilitation
Prevention of complications

Prognosis variable (but poor)