What’s the difference between anterior and posterior cord syndrome?

According to 2020 data provided by National Spinal Cord Injury Statistical Center, new spinal cord injury (SCI) cases occur each year. Classifying different types and the severity of traumatic spinal cord injuries is imperative not only for doctors but also for patients. This classification is used as a universal language so all SCI specialists can be on the same page as other medical professionals. Also, classifying the SCI severity can help patients to better understand their injury and potential for improvement. Two of these types of classifications of incomplete SCI involve anterior and posterior cord syndrome.

What Is Anterior Cord Syndrome?


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This spinal cord syndrome typically affects the anterior two-thirds of the spinal cord. “Anterior” refers to the area of the cord affected, which is the cord that faces the front of the body. It’s caused by an ischaemic condition, which is a lack of blood flow that provides oxygen and other nutrients to the spinal cord. As a result, some of the surrounding tissue becomes injured.

The anterior spinal cord receives its blood supply from the anterior spinal artery, so when an injury occurs near this area, it’s often compared to someone suffering a stroke. However, it’s not like a typical stroke. Instead, this type of injury occurs further along the bundle of nerves that comprise the spinal cord and doesn’t directly affect the brain.

Patients who have anterior cord syndrome usually have paralysis below the lesion level as well as a loss of temperature and pain at or below the lesion level. The outlook for patients with this type of injury is much better compared to someone who suffered a cerebral stroke.

What Are the Causes of Anterior Cord Syndrome?

When determining the causes of anterior cord syndrome, it’s important to comprehend spinal cord anatomy. Looking at a cross-section of the spinal cord, you should notice that different parts of the cord relate to certain areas of the body. They also are connected to various blood vessels, so whenever a blockage or narrowing occurs in one of these arteries, only that part of the body is affected.

As mentioned, the blood supply for the anterior spinal cord comes from the anterior spinal artery. When an injury to the anterior spinal cord happens, it’s caused by either traumatic or atraumatic events. Traumatic events involve serious accidents and disrupt the spinal cord’s blood supply. It’s likely due to compression or rupture of those blood vessels. Atraumatic events might include a ruptured aortic aneurysm that causes an interrupted blood supply or a clot in the blood supply heading to the spinal cord.

What Are Treatment Options for Anterior Cord Syndrome?

The main treatment for anterior cord syndrome is immediate hospital attention since the extent and location of the injury has a bearing on the amount of movement control and sensation that the patient can regain. Medical professionals will treat the underlying cause, which might involve surgery or medications such as steroids or blood thinners.

It’s not always possible to know immediately if the patient will recover from anterior cord syndrome. Some patients completely recover their ability to walk, while others don’t gain complete muscle control. To help them on their path to recovery, doctors might administer early tests and assign treatment and rehabilitation plans.

What Is Posterior Cord Syndrome?

Posterior cord syndrome isn’t as common as anterior cord syndrome. It affects the dorsal columns found on the posterior or backside of the spinal cord. This area is responsible for a variety of sensory information such as body positioning, vibration, sense of movement, and fine touch. Those who experience posterior cord syndrome usually experience sensory ataxia, which is impaired voluntary movement coordination. They might experience frequent falls, unsteady walking, and poor coordination.

These symptoms usually are heightened when people are in dark environments or close their eyes since the body can no longer rely on sight to maintain balance. Certain individuals might also experience sensory losses including vibration and fine touch, although they remain able to feel pain and temperature. Since the motor function involves the anterior spinal cord, those who suffer from posterior cord syndrome can walk. However, as mentioned, they might have difficulty with balance and posture.

What Are the Causes of Posterior Cord Syndrome?

Unlike anterior cord syndrome, posterior cord syndrome is almost entirely caused by an atraumatic event such as a vascular event or disease. Some examples include vitamin B12 deficiency and multiple sclerosis. Other, less common causes can include an external compression of the posterior spinal cord due to tumors and hereditary neurodegenerative disorders. It can also occur when the posterior spinal artery becomes blocked since this artery supplies blood to the spinal cord’s posterior columns. Since there are two posterior spinal arteries, the damage to the body is relegated to one side.

Medical professionals can diagnose posterior cord syndrome by performing a variety of clinical tests. They can assess sensory problems by asking patients to identify different sensations such as vibrations or pain while being touched with specific tools such as a dull needle or cotton swabs. Another option is to use the Romberg test, which involves asking patients to close their eyes and stand straight while the medical professionals look for a loss of balance. If patients cannot stand straight, they might suffer from sensory ataxia.

What Are Treatment Options for Posterior Cord Syndrome?

The treatment for posterior cord syndrome varies depending on the severity of the damage done to the spinal cord. For instance, those who have a vitamin B12 deficiency might receive vitamin B12 supplements. In instances with external compression of the spinal cord, those patients might need to undergo surgery. Regardless of the treatment plan, patients will benefit from occupational and physical therapy to improve their overall balance and coordination.

If you’re interested in learning more about the anterior and posterior cord syndromes, reach out to the knowledgeable team at Scheck & Siress. As providers of custom prosthetics, spinal braces, and orthotics, we remain committed to ensuring every patient has access to the tools to help them maintain balance. Contact us today, and let us assist with your orthotics needs.