Anterior Spinal Artery Syndrome due to Intervertebral Disc Herniation: A Systematic Review

Author(s): Asraful Islam, Mohammad D Hossain, Abu Bakar Siddik, Tyfur Rahman, Ashraful Alam, Md Manjurul Islam Shourav, Nahian Afrida, Sajedur Rahman, Masum Rahman

Objective: Anterior spinal artery syndrome (ASAS) has been rarely reported as a complication of intervertebral disc herniation (IVDH). Precipitation factors, presentation, evaluation, treatment strategy, and degrees of recovery have not yet been well documented.

Methods: Systematic review was conducted according to PRISMA guidelines to review and summarize for the qualitative synthesis of the data from reported cases of anterior spinal artery syndrome due to intervertebral disc herniation from 1980 to February 2021.

Results: A total of 12 cases were reviewed, the median age was 48.5 years. Motor weakness with or without pain was the most frequent presenting symptom accompanying bowel or bladder incontinence (25%) or diminished pain and temperature sensation with spared dorsal column sensation. 40% of conservatively treated patients had complete recovery without any residual deficit. Whereas all patients who managed surgically regained fully functional status with shorter recovery intervals.

Conclusion: Abrupt onset of motor weakness is a potential warning symptom of spinal cord infarction, rarely attributed to ASA compression by a herniated disc. Moreover, an accompanying diminished pain and temperature sensation with spared dorsal column sensation is further intimation. Reestablishment of blood flow may bear a favorable outcome.

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