Total Community Care - Specialists in spinal & neurological care

Providing bespoke care nationwide for clients with spinal injuries and neurological conditions

26 Mar

What is Anterior Cord Syndrome?

Anterior cord syndrome is a condition affecting the spinal cord. ‘Anterior’ refers to the part of the cord affected; in this case, the aspect of the cord facing the front of the body. It is an ischaemic condition, meaning it is caused by lack of blood flow ‘feeding’ oxygen and nutrients to the spinal cord, resulting in injury to some of the tissues.

The anterior spinal cord is perfused by – receives its blood supply from – the anterior spinal artery; as an injury to the central nervous system caused by blood supply problems, it is most usefully compared to a stroke. It differs from what most people think of as a typical stroke, as it occurs further along the bundle of nerves comprising the spinal cord so doesn’t directly affect the brain.

The outlook for someone with an incomplete spinal cord injury like anterior cord syndrome is much better than that for someone who has had a cerebral stroke. The functional effects of an injury affecting the spinal cord are usually only found below the level of injury, though a spinal cord injury can impact on the whole body through effects on blood pressure and the autonomic nervous system – the system which controls the body functions that we don’t have any conscious control over.

Anterior cord syndrome is rare with around 40 cases per million people, according to one study in the United States. It can vary in severity from being extremely debilitating in the long term to being associated with only very mild or insignificant long-term effects.

Causes

To understand the causes, it’s essential to have some understanding of the anatomy of the spinal cord. Looking at a cross-section of the spinal cord, different areas of the cord relate to different regions of the body. They are also supplied by different blood vessels, so an occlusion – a blockage or narrowing – in one of the arteries supplying blood to the spinal cord might only impact on one of these areas. The ‘anterior’ cord is the way we describe the two-thirds of the cord facing the front of the body.

The blood supply to the anterior spinal cord is provided by the anterior spinal artery, and problems can occur for a few different reasons. Generally, vascular – blood supply – injuries to the anterior spinal cord can be caused by traumatic events or atraumatic (non-traumatic) events.

Traumatic events include injuries sustained in car crashes or other serious accidents; any injury which causes disruption to the blood supply to the anterior spinal cord, usually due to compression or rupture of those blood vessels.

Non-traumatic events include spinal artery thrombosis – a clot in the blood supply to the spinal cord, or interrupted blood supply due to a bleed such as in the case of a ruptured aortic aneurysm.

Interrupted blood supply causes an area of ischaemia – tissues that have been damaged by a lack of oxygen due to restricted blood supply. This area of damage means that some of the signals that would normally be passed through the nerves at that point cannot be transmitted properly.

This means that the information being passed to and from the brain to any part of the body supplied by those affected nerves is disrupted. This disruption can affect movement and motor control, sensation of touch, pain, and changes in temperature, and sometimes affects the action of the muscles controlling the bladder, bowels, and reproductive organs.

Diagram of cross section of spine showing anterior cord syndrome

The characteristic ischaemic areas in anterior cord syndrome

Damage to different parts of the bundles of nerves in this imaginary cross section of the spinal cord affects different functions and areas. The position along the length of the spine where damage occurs also has an effect on the result of the injury. Generally, movement and sensation are only affected below the point on the spine where the damage occurs.

It is not always possible to tell straight away how much someone will recover their abilities; some people completely recover their ability to walk, whereas others do not regain good muscle control. Early tests, treatment and rehabilitation can help predict the path of recovery.

 

Risk Factors

There are several different conditions which can lead to anterior cord syndrome, and the risk factors for these vary. Some conditions leading to vascular spinal cord injuries are the same kinds that cause any other problems with blood supply around the body – such as hardening of the arteries (arteriosclerosis or atherosclerosis), thrombosis (blood clots).

Adequate blood supply can also be interrupted by aortic aneurysm – related to heart disease, hardened arteries, and uncontrolled hypertension (high blood pressure), or by very severe hypotension (low blood pressure), such as that associated with significant blood loss.

Anterior cord syndrome can be caused by trauma, such as during a violent injury, or is listed as one of the very rare complications associated with certain spinal cord surgeries. Other conditions which can cause damage and insufficiency of the anterior spinal cord include tumours causing local pressure, or extreme cases of cervical spondylosis.

Signs and Symptoms

Anterior cord syndrome is an acute onset condition, meaning that it happens very quickly and suddenly. It may occur with no warning at all, and even at rest – people report sitting down and suddenly losing all sensation or movement in their legs. Both sides of the body are affected.

The symptoms include sudden loss of muscle strength and movement control. Some sensitivity to pain or heat is also lost, but people with anterior spinal cord syndrome, normal touch perception is usually retained. Proprioception – the sensation which lets us understand intuitively our body’s position, placement and movement – is usually unaffected by anterior cord injury. Some people lose tone and sensation to their bowels and bladder control.

The symptoms of anterior cord syndrome are enough for doctors to make a working assumption of the condition in an emergency setting, but an early MRI scan will give more indication of the exact location and severity of the condition, and will guide the treatment for the best possible prognosis.

Management

The acute phase of any spinal cord injury needs to be managed with immediate hospital attention, and from there the path to recovery is variable from person to person. The extent and location of the injury have a huge bearing on the amount of sensation and movement control which will be regained, and early, effective physiotherapy can also make a difference.

The main treatment in the initial phase of anterior cord injury is to treat the underlying cause. This may take the form of medications such as steroids and blood thinners, and some conditions causing spinal cord damage will need surgical treatment.

Someone with an anterior spinal cord syndrome is likely to have to take medications for life. These will depend on the initial cause of the problems, but may include blood thinners and treatments to manage disease affecting the blood vessels, such as treatments for cholesterol or high blood pressure.

Most people with spinal cord injuries will require a period of rehabilitation to help recover as much of their functional ability as possible in a safe, supportive environment. Long or short stays in spinal injury centres or on specialist rehab wards may be beneficial, but some people are able to live at home with provisions to meet their care needs, and can attend rehab centres through the day, or have home physiotherapy in some circumstances. The extent and success of rehabilitation prior to discharge from hospital is a strong indicator of the ongoing care needs for that person.

Ongoing needs

The severity of anterior cord syndrome can vary widely, and so any ongoing care needs must be assessed on an individual, case-by-case basis. Physiotherapy plays a huge part in improving function, particularly in the first few weeks after the onset of symptoms. People who are admitted to hospital with anterior cord syndrome tend to have longer hospital stays than those with other incomplete spinal cord injuries, but often show lots of functional improvement with extensive physical and functional therapies.

As the sensation of pain is so often impaired after an anterior spinal cord injury, an increased awareness and mindfulness of the surroundings is essential – many people retain the sense of touch to the areas affected by injury only to the anterior part of the spinal cord, but might not be able to tell the difference between normal touch and, for example, a serious burn or cut. People with loss of sensation – particularly pain sensation – should be extra cautious when it comes to any injury or danger.

The degree of muscle weakness and the extent of reduced mobility will be the main factor determining ongoing needs, and the greater the reduction in ability compared to the person’s pre-injury state, the more consideration needs to go into maintaining their standard of living and pursuing normal activities. People with any spinal cord injuries may have increased mobility needs, requiring wheelchair use, accessible housing, specialist equipment in the home, and sometimes a change of location. These needs should be taken into consideration prior to discharge from hospital, and a comprehensive occupational health assessment should be undertaken, with adaptations and equipment as required.

Other needs to consider include continence care, skin and pressure area care, meeting nutritional needs, and maintaining a healthy lifestyle, social life, and good mental health. A life-changing medical condition or care need can have a serious impact on mental health and emotional wellbeing and so planning for ongoing care needs must take this into account.

Care in the Community

For those who have ongoing, long-term extra needs, whether personal care such as help with washing and dressing, household tasks and normal day-to-day activities, there will be an assessment of your ongoing care needs. This may initially take the form of a multi-disciplinary team meeting in a rehabilitation centre, to work out the best way to get you home safely and with all the necessary assistance available.

Choosing a care provider who specialises in clients with spinal cord injuries means you’ll get the best care for yourself and your condition. At Total Community Care, we work with our clients to build exactly the right team and package of care for the individual, acting as facilitators for our clients to choose their own carers. We believe that you should have total control over the people you allow into your home and your life.

Lady in wheelchair with family and friends standing around her

The extent of your ongoing needs will inform the kind of care you choose – Further down the line, it may be that your care needs at home change, and that’s when it’s important to have a dedicated care manager overseeing a team of professionals and experienced carers who can provide continuous, ongoing assessments of any changing needs.

Again, the importance of emotional wellbeing cannot be overstated, at a time of great change, with the challenges of a new long-term medical condition, and when it might seem like previously easy and enjoyable activities, work, family, and social life take a lot more planning and effort than previously. Having a team dedicated to helping you maintain the kind of life you want to continue leading can make all the difference, and a care provider who values your choices and quality of life is essential.

At Total Community Care, we specialise in helping clients with significant care needs, setting up 24-hour-a-day care at home. We help you find the right team for you, taking into account the kind of lifestyle you want to lead. Our staff can travel with you, enable you to work and continue your family and social life as normal. We believe that when you work that closely with someone, you should have a chance to meet them beforehand, and assemble a team of people you enjoy spending time with, who are also experienced and exemplary professionals with a background and particular interest in medical and social care for people with long term needs.

If you’d like to discuss your home care needs and desires with a specialist spinal injury care provider, get in touch with us at Total Community Care.

Reference Material

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2031952/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264724/

 

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