Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Blockage of the Blood Supply to the Spinal Cord

(Spinal Cord Infarction; Ischemic Myelopathy)

By

Michael Rubin

, MDCM, New York Presbyterian Hospital-Cornell Medical Center

Last full review/revision Jun 2021| Content last modified Jun 2021
Click here for the Professional Version

Blockage of an artery carrying blood to the spinal cord prevents the cord from getting blood and thus oxygen. As a result, tissues can die (called infarction).

  • Causes include severe atherosclerosis, inflammation of blood vessels, blood clots, and sometimes procedures that involve the abdominal aorta.

  • Sudden back pain with pain radiating from the affected area is followed by muscle weakness and inability to feel heat, cold, or pain in the affected areas and sometimes paralysis.

  • Magnetic resonance imaging or myelography with computed tomography is usually done.

  • Treatment focuses on correcting the cause if possible or relieving symptoms.

  • Spinal cord dysfunction and paralysis are usually permanent.

Like all tissues in the body, the spinal cord requires a constant supply of oxygenated blood. Only a few arteries, which are branches of the aorta, supply blood to the front part of the spinal cord. But this blood accounts for three fourths of the blood the spinal cord receives. Thus, blockage of any one of these arteries can be disastrous. Such a blockage occasionally results from the following:

  • Severe atherosclerosis of the aorta (deposits of fatty material in the aorta's wall)

  • Separation of the layers of the aorta's wall (aortic dissection)

  • Procedures that involve the abdominal aorta, such as surgery to repair a bulge (aneurysm) there

  • A blood clot that breaks off from the wall of the heart and travels through the bloodstream (becoming an embolus)—an uncommon cause

  • Inflammation of blood vessels (vasculitis), such as polyarteritis nodosa—a rare cause

Symptoms

The first symptoms of a blocked spinal cord artery are usually

  • Sudden back pain that radiates from the center of the back around the rib cage and chest

The pain is followed by muscle weakness, and people cannot feel heat, cold, or pain in areas controlled by the part of the spinal cord below the level of the blockage. People immediately notice symptoms, which may lessen slightly over time.

If the blood supply to the front of the spinal cord is greatly reduced, the legs are numb and paralyzed. But sensations transmitted through the back of the cord—including touch, the ability to feel vibration, and the ability to sense where the limbs are without looking at them (position sense)— remain intact because the back of the cord receives blood from other sources. Problems may partly resolve after the first few days.

Weakness and paralysis can lead to the development of pressure sores and breathing difficulties. Bladder and bowel function may be impaired, as may sexual function.

Diagnosis

  • Magnetic resonance imaging or myelography with computed tomography (CT)

  • Sometimes a spinal tap

Blockage of the spinal cord’s blood supply is usually suspected based on symptoms.

Magnetic resonance imaging (MRI) usually enables doctors to diagnose such a blockage. If MRI is unavailable, myelography with CT, is done. These tests can help doctors rule out other disorders that cause similar symptoms.

A spinal tap (lumbar puncture) may also be done to rule out other disorders that cause similar symptoms, such as transverse myelitis.

Angiography can confirm that an artery to the front of the spinal cord is blocked, but it is usually unnecessary.

Treatment

  • Treatment of the cause when possible

  • Relief of symptoms

When possible, the cause (such as aortic dissection or polyarteritis nodosa) is treated, but otherwise, treatment focuses on relieving symptoms and managing complications, especially when paralysis and spinal cord dysfunction do not resolve in the first few days and become permanent.

Because some sensations are lost and paralysis may develop, preventing pressure sores from forming is important.

Because breathing can be affected, therapy to help prevent pneumonia from developing may be necessary. Such therapy includes deep breathing exercises, postural drainage (positioning the person so that gravity helps drain secretions from the lungs), and suctioning (inserting a small plastic tube through the nose and into the windpipe to gently suck out secretions).

Physical therapy and occupational therapy can help preserve muscle function.

Because bladder function is usually impaired, a catheter is needed to drain urine. This treatment prevents the bladder from enlarging and being damaged.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
Others also read

Test your knowledge

Bell Palsy
Bell palsy is sudden weakness or paralysis of the muscles on one side of the face due to malfunction of the seventh cranial nerve. This nerve moves facial muscles, stimulates salivary and tear glands, detects tastes, and controls a muscle involved in hearing. Which of the following is often the first symptom of Bell palsy?
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
TOP