Anterior Spinal Artery Syndrome in a Patient with Cervical Spondylosis Demonstrated by CT Angiography

Orthop Surg. 2019 Dec;11(6):1220-1223. doi: 10.1111/os.12555. Epub 2019 Nov 3.


A few published reports have described anterior spinal artery syndrome (ASAS) with cervical spondylosis based on clinical presentation and/or MRI study, but no photographs of anterior spinal arteries were provided in these studies. Here we present a case of ASAS with cervical spondylosis in a CT angiography (CTA) study. A previously healthy 31-year-old man was diagnosed with acute ASAS with cervical spondylosis. Neurological examination revealed four-limb weakness predominant in the distal part of the upper limbs and superficial sensory impairment below the cervical region. T2-weighted images on MRI showed an area of hyperintensity in the gray matter of the cervical cord from C3 to C5 with a disc herniation at the C4,5 vertebral level. CTA demonstrated that ASA was occluded at level C4,5 , which coincided with the location of disc herniation. Anterior spinal cord decompression and fusions were performed. The patient tolerated the procedure well and had complete resolution of his exertionally dependent myelopathic symptoms 1 week later. In conclusion, although ASAS with cervical spondylosis is rare, it can be diagnosed based on clinical symptoms and MRI and identified by CTA of ASA. A good neurological prognosis is anticipated after anterior spinal cord decompression and fusion is performed if disc herniation is responsible for ASA occlusion.

Keywords: Anterior spinal artery; Anterior spinal artery syndrome; CT angiography; Cervical spondylosis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anterior Spinal Artery Syndrome / diagnostic imaging*
  • Anterior Spinal Artery Syndrome / etiology*
  • Anterior Spinal Artery Syndrome / surgery
  • Computed Tomography Angiography
  • Decompression, Surgical
  • Humans
  • Intervertebral Disc Displacement / complications*
  • Intervertebral Disc Displacement / diagnostic imaging*
  • Intervertebral Disc Displacement / surgery
  • Male
  • Neurologic Examination
  • Spinal Fusion
  • Spondylosis / complications*
  • Spondylosis / diagnostic imaging*
  • Spondylosis / surgery