Spinal Cord Infarction (SCIF)
Spinal Cord Infarction (SCIF)
Spinal cord infarction (SCIF), also known as ischemic myelopathy or spinal stroke, is a rare but serious condition caused by interruption of blood flow to the spinal cord, leading to ischemia and subsequent tissue death. It most commonly results from ischemia originating in an extravertebral artery supplying the spinal cord, such as branches from the aorta.
Pathophysiology
- The spinal cord is primarily supplied by the anterior spinal artery (supplying the anterior two-thirds) and paired posterior spinal arteries (supplying the posterior third).
- The artery of Adamkiewicz, a major feeder artery arising from the lower thoracic or upper lumbar region, is critical for perfusion of the anterior spinal cord.
- Collateral circulation is sparse in certain segments (notably T2–T4), making these areas particularly vulnerable to ischemia.
- Causes include atherosclerosis, aortic dissection, surgical clamping of the aorta, trauma, thrombosis (rare), and vasculitis (e.g., polyarteritis nodosa). Intrinsic spinal artery disorders are less common.
Clinical Presentation
- Sudden onset of severe back pain, often described as sharp or tight, sometimes radiating circumferentially around the torso.
- Rapid progression within minutes to hours to bilateral flaccid limb weakness or paralysis, usually affecting the legs (paraparesis) but can involve arms if cervical cord is affected.
- Sensory loss predominantly affects pain and temperature sensation (spinothalamic tract), while proprioception and vibration sense (posterior columns) and often light touch are relatively spared. This pattern corresponds to anterior spinal artery syndrome.
- Small infarcts affecting central cord tissue may cause central cord syndrome.
- Autonomic dysfunction may manifest as bladder and bowel incontinence, sexual dysfunction, and blood pressure instability.
- Cervical infarcts can lead to respiratory difficulties or failure.
Diagnosis
- MRI is the gold standard for diagnosis, showing spinal cord edema and infarction patterns. Early MRI may be normal; repeat imaging may be necessary.
- CT myelography may be used if MRI is unavailable, primarily to exclude compressive causes.
- Differential diagnosis includes acute transverse myelitis, compressive myelopathy, demyelinating diseases, and spinal tumors.
- Additional tests may include blood work, cerebrospinal fluid analysis, and vascular imaging (CT angiography, MR angiography) to identify underlying vascular pathology.
Treatment
- No specific therapy reverses spinal cord infarction; treatment is primarily supportive.
- Manage underlying causes if identified (e.g., surgical repair of aortic dissection, immunosuppression for vasculitis).
- High-dose corticosteroids are generally not recommended unless inflammatory causes are suspected.
- Early rehabilitation (physical and occupational therapy) is critical to maximize functional recovery.
- Supportive care includes pain management, bladder and bowel care, and prevention of complications such as pressure ulcers and deep vein thrombosis.
Prognosis
- Variable; some patients experience partial neurological recovery over days to weeks, while others have permanent deficits.
- Prognosis depends on infarct size, location, speed of onset, and promptness of supportive care.
- Mortality is higher with cervical infarcts due to respiratory compromise.
Summary Table
| Aspect | Details |
|---|---|
| Definition | Ischemic injury to the spinal cord due to interrupted blood flow |
| Common Causes | Aortic pathology (dissection, surgery), atherosclerosis, thrombosis, vasculitis |
| Blood Supply | Anterior spinal artery (anterior 2/3), posterior spinal arteries (posterior 1/3), artery of Adamkiewicz |
| Symptoms | Sudden severe back pain, bilateral flaccid weakness, loss of pain and temperature sensation, autonomic dysfunction |
| Diagnosis | MRI (gold standard), CT myelography, vascular imaging, CSF analysis |
| Treatment | Supportive care, treat underlying cause, rehabilitation |
| Prognosis | Variable; partial recovery possible; worse with cervical involvement |
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References
- Rubin M. Spinal Cord Infarction. MSD Manual Professional Version. Updated March 2025.
https://www.msdmanuals.com/professional/neurologic-disorders/spinal-cord-disorders/spinal-cord-infarction - National Institute of Neurological Disorders and Stroke (NINDS). Spinal Cord Infarction.
https://www.ninds.nih.gov/health-information/disorders/spinal-cord-infarction - Medscape. Spinal Cord Infarction Clinical Presentation and Diagnosis.
https://emedicine.medscape.com/article/1164217-clinical - StatPearls. Spinal Cord Infarction.
https://www.ncbi.nlm.nih.gov/books/NBK545185/ - Neurologia (English Edition). Spinal cord infarction: aetiology, imaging findings, and prognostic factors.
https://www.elsevier.es/en-revista-neurologia-english-edition–495-articulo-spinal-cord-infarction-aetiology-imaging-S2173580821000778 - Cleveland Clinic. Spinal Stroke: What It Is, Causes, Symptoms & Treatment.
https://my.clevelandclinic.org/health/diseases/28018-spinal-stroke
Spinal cord infarction is a rare but critical cause of sudden spinal cord dysfunction, characterized by acute back pain and rapid onset of bilateral motor and sensory deficits. MRI is essential for diagnosis, and treatment focuses on supportive care and addressing underlying causes. Early rehabilitation improves outcomes.
