SPINAL CORD ISCHEMIA

Atherosclerosis:

Atherosclerosis is a common cause of spinal cord ischemia, especially in older adults. It involves the buildup of plaque within the arteries supplying the spinal cord, leading to narrowing and reduced blood flow. Plaque formation can result from the accumulation of cholesterol, fatty deposits, and inflammatory cells in the arterial walls, ultimately restricting blood flow to the spinal cord.

Embolic Events:

Embolic events occur when blood clots or other debris dislodge from their site of origin and travel through the bloodstream.  When they become lodged in a smaller artery supplying the spinal cord they stop blood carrying the oxagen. These emboli can originate from various sources, including the heart (e.g., atrial fibrillation, endocarditis), large arteries (e.g., carotid artery disease), or other parts of the body (e.g., deep vein thrombosis). Once lodged in a spinal artery, emboli can obstruct blood flow and cause ischemic injury to the spinal cord.

Aortic Pathologies:

Conditions affecting the aorta, the main artery of the body, can lead to spinal cord ischemia. Aortic pathologies such as aortic dissection, aortic aneurysm, and atherosclerotic plaque formation can impair blood flow.  When this occurs the spinal cord will become compromised because of vascular insufficiency in the arteries branching off the aorta.

Spinal Cord Trauma:

Traumatic injuries to the spine can disrupt the blood supply to the spinal cord, resulting in ischemia and subsequent neurological deficits. These injuries may include vertebral fractures, spinal cord contusions, or compression injuries caused by trauma-related hematoma or swelling. The disruption of blood vessels supplying the spinal cord can lead to hemorrhage, thrombosis, or vasospasm.  These conditions will ultimately compromise blood flow causing ischemic damage.

Vascular Malformations:

Congenital or acquired vascular malformations in the spinal cord or adjacent structures can predispose individuals to spinal cord ischemia. These malformations, such as arteriovenous malformations (AVMs), arteriovenous fistulas (AVFs), or cavernous malformations, disrupt normal blood flow patterns.  These conditions may lead to localized ischemia if blood flow is diverted away from critical spinal cord regions.

Inflammatory Disorders:

Certain inflammatory conditions affecting the blood vessels, such as vasculitis, can result in inflammation and damage to the vascular walls.  This condition can lead to impaired blood flow and ischemia. Inflammatory disorders like giant cell arteritis, systemic lupus erythematosus (SLE), and rheumatoid arthritis can affect both large and small vessels.  When these condition affect the blood supply to the spinal cord, it can increase the risk of ischemic injury.

Thrombotic Disorders:

Thrombotic disorders, characterized by abnormal blood clotting within the vasculature, can occlude spinal arteries and cause ischemia. Conditions such as antiphospholipid syndrome, thrombophilias, and coagulopathies can predispose individuals to thrombotic events, resulting in vascular occlusion and subsequent spinal cord ischemia.

Surgical Complications:

In some cases, spinal cord ischemia may occur as a complication of spinal surgery or other surgical procedures involving the thoracic or abdominal aorta. Surgical manipulation of the aorta or adjacent blood vessels can disrupt blood flow to the spinal cord, leading to ischemic injury and neurological deficits.

Overall, spinal cord ischemia can arise from a variety of causes, including vascular diseases, embolic events, traumatic injuries, vascular malformations, inflammatory disorders, thrombotic disorders, and surgical complications. Identifying the underlying cause is essential for guiding treatment and preventing further neurological damage.

Spinal cord ischemia occurs when the blood supply to the spinal cord is compromised, leading to a range of neurological symptoms that can vary depending on the severity, location, and duration of the ischemic insult. The symptoms of spinal cord ischemia typically manifest as neurological deficits below the level of the affected spinal cord segment. Here are the different symptoms associated with spinal cord ischemia:

Weakness and Paralysis:

One of the hallmark symptoms of spinal cord ischemia is weakness or paralysis in the affected regions of the body. Depending on which spinal cord segments are affected, individuals may experience weakness or paralysis in the arms, legs, or both. The weakness may range from mild to severe and can significantly impair mobility and function.

Sensory Disturbances:

Spinal cord ischemia can also lead to sensory disturbances, including numbness, tingling, or loss of sensation below the level of the injury. Patients may experience sensory deficits in various modalities, such as touch, temperature, vibration, and proprioception. These sensory abnormalities may be unilateral or bilateral, depending on the extent of spinal cord involvement.

Pain:

Spinal cord ischemia can cause neuropathic pain, characterized by burning, shooting, or stabbing sensations in the affected areas. The pain may be localized to the back or radiate to other parts of the body innervated by the affected spinal cord segments. Neuropathic pain can be debilitating and may significantly impact the individual’s quality of life.

Loss of Reflexes:

Spinal cord ischemia can result in the loss of deep tendon reflexes below the level of the injury. Reflexes such as the patellar reflex (knee jerk) or Achilles reflex (ankle jerk) may be diminished or absent on physical examination. The loss of reflexes is indicative of spinal cord dysfunction and can help localize the level of the injury.

Bowel and Bladder Dysfunction:

Spinal cord ischemia may disrupt the autonomic nervous system pathways that control bowel and bladder function. Patients may experience urinary or fecal incontinence, urinary retention, or difficulty initiating and maintaining voiding. Bowel and bladder dysfunction can significantly impact the individual’s quality of life and may require intervention for management.

Sexual Dysfunction:

Dysfunction of the spinal cord pathways involved in sexual function can occur with spinal cord ischemia. Both men and women may experience erectile dysfunction, loss of libido, or difficulty achieving orgasm. Sexual dysfunction can have a profound effect on intimate relationships and may necessitate counseling or medical intervention.

Motor Coordination and Balance Issues:

Spinal cord ischemia can affect motor coordination and balance, leading to difficulties with walking, coordination, and balance. Patients may experience gait disturbances, clumsiness, or a feeling of unsteadiness when walking or standing. These motor deficits can increase the risk of falls and injuries.

Spasticity:

In some cases, spinal cord ischemia can lead to spasticity, characterized by involuntary muscle contractions and stiffness in the affected limbs. Spasticity may manifest as muscle tightness, spasms, or exaggerated reflexes. Severe spasticity can interfere with mobility and may require treatment with medications or physical therapy.

Overall, the symptoms of spinal cord ischemia can significantly impact an individual’s function and quality of life. Early recognition and management of these symptoms are essential for optimizing outcomes and preventing further neurological deterioration.

Diagnosis:

Doctors diagnose spinal cord ischemia through a combination of medical history, physical examination, and diagnostic tests. Imaging studies such as MRI or CT scans can help identify abnormalities in the spinal cord and blood vessels. Electrophysiological tests like electromyography (EMG) or nerve conduction studies may assess nerve function.

Nonsurgical Treatment:

Nonsurgical treatments for spinal cord ischemia aim to improve blood flow and manage symptoms. This may include medications such as anticoagulants to prevent blood clots, vasodilators to widen blood vessels, and pain relievers to alleviate discomfort. Physical therapy and rehabilitation can help restore function and mobility.

Surgical Treatment:

Surgical treatment for spinal cord ischemia aims to address the underlying cause of reduced blood flow to the spinal cord and restore adequate circulation to prevent further damage and improve neurological function. The specific approach to surgery depends on the underlying cause of ischemia and the extent of spinal cord injury. Whenever possible, the surgeons at the Southwest Scoliosis and Spine Institute will employ Minimally Evasive Spine Surgery.

Vascular Bypass Surgery:

In cases where there is a blockage or narrowing of major blood vessels supplying the spinal cord, vascular bypass surgery may be performed. During this procedure, a vascular surgeon creates a new pathway for blood flow by grafting a healthy blood vessel from another part of the body or using artificial graft material to bypass the blocked or narrowed segment. By rerouting blood flow around the obstruction, this surgery helps restore adequate blood supply to the spinal cord.

Endovascular Procedures:

The endovascular techniques involve accessing the blood vessels through minimally invasive methods, typically via catheterization through the arteries. Endovascular procedures may include angioplasty, where a balloon catheter is used to widen narrowed blood vessels, or stent placement to keep the vessels open. In cases of embolism, where a blood clot has lodged in a spinal artery, thrombectomy or clot retrieval procedures may be performed to remove the clot and restore blood flow.

Spinal Decompression Surgery:

In some cases, spinal cord ischemia may result from compression of the spinal cord due to conditions like spinal stenosis or herniated discs. Spinal decompression surgery aims to relieve pressure on the spinal cord by removing bone or tissue that is compressing the nerves. This may involve procedures such as laminectomy, discectomy, or spinal fusion to stabilize the spine and alleviate compression.

Revascularization Techniques:

In rare cases of chronic spinal cord ischemia where blood flow is severely compromised, more advanced revascularization techniques may be considered. These may include arterial bypass grafting using autologous or synthetic grafts to create new blood pathways, or complex procedures involving spinal artery ligation or reconstruction.

Neuroprotective Strategies:

Alongside surgical interventions to restore blood flow, neuroprotective measures may be employed to minimize further damage to the spinal cord tissue. This may involve the administration of medications such as steroids or antioxidants to reduce inflammation and oxidative stress, as well as strategies to optimize spinal cord perfusion and support tissue recovery.

It is important to note that the choice of surgical treatment depends on various factors, including the underlying cause of spinal cord ischemia, the severity of neurological deficits, and the patient’s overall health status. Surgical interventions are often part of a comprehensive treatment approach that may also include medical management, rehabilitation, and ongoing monitoring to optimize outcomes and improve quality of life for individuals affected by spinal cord ischemia.

Benefits of Surgical Treatment:

Surgery for spinal cord ischemia can offer several benefits aimed at alleviating symptoms, restoring blood flow to the spinal cord, and preventing further neurological damage. These benefits may vary depending on the underlying cause of ischemia, the extent of spinal cord injury, and the specific surgical approach employed. Here are some potential benefits of surgery for spinal cord ischemia:

Restoration of Blood Flow:

One of the primary goals of surgical intervention is to restore adequate blood flow to the spinal cord. By addressing the underlying cause of ischemia, such as arterial blockages or compression of blood vessels, surgery aims to improve perfusion to the affected spinal cord segments. This restoration of blood flow can help prevent further ischemic injury and promote tissue healing and recovery.

Neurological Improvement:

Surgery may lead to neurological improvement in patients with spinal cord ischemia, particularly if performed promptly after the onset of symptoms. By relieving pressure on the spinal cord, decompressing nerve roots, or revascularizing compromised blood vessels, surgical intervention can help alleviate symptoms such as pain, weakness, numbness, and impaired mobility. In some cases, surgical treatment may also halt the progression of neurological deficits and promote functional recovery.

Prevention of Permanent Damage:

Timely surgical intervention can help prevent permanent damage to the spinal cord tissue and mitigate the risk of irreversible neurological deficits. By addressing the underlying cause of ischemia and restoring blood flow, surgery aims to limit the extent of tissue injury and preserve spinal cord function. This proactive approach can be critical in minimizing long-term disability and optimizing patient outcomes.

Pain Relief:

Surgery may provide significant relief from pain associated with spinal cord ischemia, particularly if the pain is caused by nerve compression or irritation. By decompressing spinal nerves, removing herniated discs, or stabilizing the spine, surgical treatment can alleviate pain symptoms and improve overall quality of life for affected individuals.

Prevention of Complications:

Spinal cord ischemia can lead to various complications, including paralysis, loss of bladder and bowel control, and impaired sensation. Surgery aims to mitigate the risk of these complications by addressing the underlying vascular or structural abnormalities contributing to ischemia. By restoring blood flow and relieving pressure on the spinal cord, surgical intervention can reduce the likelihood of secondary complications and improve overall patient prognosis.

Improved Functional Outcomes:

For patients experiencing neurological deficits due to spinal cord ischemia, surgery offers the potential for improved functional outcomes and enhanced mobility. By optimizing spinal cord perfusion and addressing contributing factors such as spinal stenosis or vascular abnormalities, surgical treatment can help patients regain strength, sensation, and coordination, enabling them to resume daily activities and improve their quality of life.

Overall, surgery for spinal cord ischemia plays a crucial role in addressing the underlying causes of ischemia, relieving symptoms, and promoting neurological recovery. While the specific benefits may vary depending on individual patient factors and the nature of the underlying condition, surgical intervention offers a proactive and targeted approach to managing spinal cord ischemia and optimizing patient outcomes.

Recovery Period:

Recovery from spinal cord ischemia depends on the severity of the condition, the extent of neurological damage, and the effectiveness of treatment. Rehabilitation efforts, including physical therapy, occupational therapy, and assistive devices, play a crucial role in the recovery process. Recovery periods can vary widely among individuals.

Rehabilitation:

Rehabilitation after spinal cord ischemia focuses on maximizing function, independence, and quality of life. This may involve a multidisciplinary approach, including physical therapy, occupational therapy, speech therapy, and psychological support. Assistive devices and adaptive techniques can help individuals manage daily activities and improve mobility.

Reasons to Choose The Southwest Scoliosis and Spine Institute:

The Southwest Scoliosis and Spine Institute, led by renowned spine surgeons Doctors Richard A. Hostin, Devish Ramnath, and Ishaq Syed, offers comprehensive care for spinal cord ischemia. With state-of-the-art facilities and a multidisciplinary team, they provide personalized treatment plans tailored to each patient’s needs. Their expertise, experience, and commitment to excellence make them a trusted choice for individuals seeking top-quality spinal care. Located in Dallas, Plano, and Frisco, Texas, their convenient locations ensure accessible and compassionate care for patients with spinal cord ischemia.

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National Institute of Health: Spinal Cord Ischemia