Spinal vascular diseases are a group of disorders caused by blockage or rupture of the blood vessels supplying the spinal cord, leading to spinal cord dysfunction. The blood supply to the cervical spinal cord comes from the vertebral {|###|}stirred pulse{|###|}, and the bilateral vertebral {|###|}stirred pulses{|###|} merge to form the anterior spinal {|###|}stirred pulse{|###|}, which descends. The thoracic spinal cord is supplied by the intercostal {|###|}stirred pulses{|###|}. The lower thoracic and lumbar spinal cord are supplied by the descending branches of the main {|###|}stirred pulse{|###|} and the branches of the internal iliac {|###|}stirred pulse{|###|}. The anterior spinal {|###|}stirred pulse{|###|} supplies the ventral two-thirds of the spinal cord, while the posterior spinal {|###|}stirred pulse{|###|} supplies the dorsal one-third. The lateral regions are supplied by the circumferential spinal {|###|}stirred pulse{|###|}. The spinal cord segments T_{2 to T}4 are the junction between the cervical vertebral {|###|}stirred pulse{|###|} and the thoracic spinal cord, where the blood supply is relatively poor.

bubble_chart Etiology

Spinal ischemic vascular disease is mostly caused by segmental artery occlusion, such as distal main artery atherosclerosis, plaque detachment, and thrombosis. Dissecting aneurysms leading to intercostal or lumbar artery occlusion, thoracic or spinal surgery, cervical spondylosis, intrathecal drug injection, and complications from selective spinal angiography. Additionally, reduced perfusion pressure due to myocardial infarction or cardiac arrest is also one of the causes of spinal ischemia. Spinal hemorrhagic vascular diseases are classified by location into epidural, subdural, subarachnoid, and intramedullary hemorrhage. Disease causes include trauma, spinal vascular malformations, hematologic disorders, and secondary bleeding from tumors. The most common spinal vascular malformations are racemose venous malformations and arteriovenous malformations. These are often located posterior to the thoracolumbar spinal cord and can compress the spinal cord or cause bleeding, leading to symptoms.

The most common manifestations of ischemic myelopathy are anterior spinal artery syndrome and posterior spinal artery syndrome. Occlusion of the anterior spinal artery leads to sudden onset of radicular pain, which peaks within hours to days, resulting in paralysis of the limbs below the lesion. It presents as dissociated sensory loss, with loss of pain and temperature sensation below the lesion while proprioception and vibration sense remain intact. The thoracic segment is more commonly affected. Incomplete occlusion of the anterior spinal artery may cause sensory abnormalities, only grade I paralysis, and bladder or rectal dysfunction. Occlusion of the posterior spinal artery often results in mild neurological symptoms due to good collateral circulation. Clinical manifestations include radicular pain, sensory loss below the lesion, ataxia, and loss of tendon reflexes, but bladder and rectal dysfunction are rare.

Spinal ischemia is seen in atherosclerosis of the main arteries. Transient ischemic attacks (TIA) of the spinal cord present as sudden paraplegia, lasting tens of minutes or hours with complete recovery. If complete infarction occurs in several spinal segments, symptoms include radicular pain, lower limb paralysis, total sensory loss, and bowel and bladder dysfunction.

Spinal subarachnoid hemorrhage has a sudden onset, with low back and lower limb pain, Kernig's sign positivity, and bloody cerebrospinal fluid. If blood enters the cerebral subarachnoid space, it can cause headache and neck stiffness. Intraspinal hemorrhage has a sudden onset, with severe back pain radiating along nerve roots, followed by signs of partial or complete transverse spinal cord damage. Since hemorrhage often occurs in the central part of the spinal cord, sensation in the lumbosacral dermatomes may remain intact. If a large amount of intraspinal hemorrhage ruptures into the subarachnoid space, meningeal irritation signs and bloody cerebrospinal fluid may occur.

bubble_chart Diagnosis

Spinal enhanced CT, MRI, and spinal stirred pulse digital subtraction angiography (DSA) are essential evidence for the definitive diagnosis of this disease. Spinal vascular malformations often need to be differentiated from herniation of intervertebral disc, multiple sclerosis, and spinal arachnoiditis due to their recurrent episodes. Spinal TIA can be distinguished from multiple sclerosis by the fixed location and similar symptoms of each episode.

bubble_chart Treatment Measures

Patients with spinal vascular malformations should choose between catheter interventional therapy or surgical resection based on the size and distribution of the malformation. Those with residual paraplegia should undergo rehabilitation treatment and nursing care following the convalescence stage protocol for myelitis.