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  • Updated 10.26.2023
  • Released 06.17.1996
  • Expires For CME 10.26.2026

Vascular disorders of the spinal cord



Spinal cord vascular disorders are rare, though potentially devastating, conditions that require prompt recognition and treatment. These vascular disorders are heterogenous in origin, with pathologies involving both the arterial and venous vessels. Understanding the clinical hallmarks and potential etiologies are necessary to provide effective intervention and timely management. Most treatment strategies are reliant on a multidisciplinary team.

Key points

• Spinovascular disorders are relatively rare and encompass a wide breadth of etiologic designations.

• The majority of acute spinovascular processes have back or radicular pain.

• Classic intramedullary spinal cord disorders follow well-defined neurovascular territories.

• The etiologies of these conditions are heterogenous, including embolic, iatrogenic, hypotensive, ischemic, hemorrhagic, and congestive pathologies.

• Treatment requires a multidisciplinary effort and may require an interventional approach.

• Owing to the rarity of the disease, much is not robustly known on the outcomes of those with a spinovascular condition.

Historical note and terminology

Although the presence of a spinal epidural hematoma (termed “spinal apoplexy”) was possibly first described in 1682 by GJ Duverney, intramedullary spinovascular disease was not readily identified until the 1800s. In 1817 and 1857, early cases reported spinovascular complications ranging from abdominal aortic aneurysm to the development of paraplegia (112). In 1881 and 1882, Polish pathologist Albert Adamkiewicz provided insight into the vascular anatomy of the spinal cord (71). His work allowed for further characterization of spinal cord vascular syndromes, including the first report of an anterior spinal artery syndrome in 1909 (117). In addition to large artery spinovascular complications, more intricate pathologies were identified. In 1912, Marie and Foix described the syndrome of "tephromalacie anterieure," or ischemic lesions in the anterior horn cells due to atherosclerotic disease (73). In 1926, Foix and Alajouanine subsequently described a congestive myelopathy from two cases of spinal dural arteriovenous fistulas (30). Embolization of spinal dural arteriovenous fistula was subsequently reported by Newton and Adams in 1968 (86). With the increasing interest in cardiovascular surgeries in the 1970s, reports emerged of incidences of anterior spinal cord syndrome related to hypoperfusion (113). More recent advances in neuroimaging have more readily identified spinovascular disorders, such as spinal dural arteriovenous fistula and stroke.

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