Rehabilitative Management of the Anterior Spinal Artery Syndrome (ASAS) Patient

Author(s): John DesRochers, Dev Patel, Brian Clayton, Akash Patel, Jacob Rauh, Brandon J Goodwin, Gilbert Siu DO

Anterior Spinal Artery Syndrome (ASAS) is a rare pathology affecting the anterior 2/3 of the spinal column, most commonly developing iatrogenically following aortic surgery. Due to the high degree of permanent disability and dysfunction, optimized medical treatment is vital for disease management. The purpose of this literature review is to provide the first comprehensive management guide for the rehabilitation of ASAS. One of the most important means of ASAS management is immediate reversal of the offending etiology once identified. A patient-centric interdisciplinary approach should be employed in physical rehabilitation of this pathology’s sequelae. Recent studies have shown that in addition to medical management, physical therapy is crucial for flaccid paraplegia. Additionally, nerve transfer surgery may prove beneficial in denervated musculature. Management of pain and spasticity should include NSAIDs, tricyclic antidepressants, muscle-relaxants, baclofen, and botulinum toxin. Botulinum toxin may also be employed in cases of neurogenic bladder. Spinal cord stimulation has shown some promise in management of pain and spasticity. To ensure whole-person treatment, providers should also endeavor to address less commonly discussed sequelae such as sexual function and psychological distress. ASAS is a challenging condition to manage long term, but an interdisciplinary team that takes a patientcentered approach to managing the diverse symptomatic manifestations discussed in this review can foster improved quality of life for patients.