Ventral cord syndrome (also known as anterior cord syndrome) is one of the incomplete cord syndromes and affects the anterior parts of the cord resulting in a pattern of neurological dysfunction dominated by motor paralysis and loss of pain, temperature and autonomic function. Anterior spinal artery ischaemia is the most common cause.
Ventral cord syndrome encompasses all causes of damage to the anterior spinal cord regardless of aetiology (see below). In contrast, anterior spinal artery syndrome, also known as Beck's syndrome, denotes a ventral cord syndrome specifically due to ischaemia/infarction of the anterior two-thirds of the spinal cord due to involvement of the anterior spinal artery.
Involvement of the anterior half to two-thirds of the spinal cord results in a predictable pattern of neurological impairment consisting of:
- complete motor paralysis below the level of the lesion due to involvement of the anterior horn cells and corticospinal tracts
- loss of pain and temperature at and below the level of injury due to involvement of spinothalamic tracts
- autonomic dysfunction: orthostatic hypotension due to involvement of lateral horn cells 6
- bladder and bowel dysfunction and sexual dysfunction may arise depending on the level of the lesion
Importantly 2-point discrimination, proprioception and vibratory senses are normal due to intact posterior columns and posterior grey matter.
Ventral cord syndrome is caused by a variety of processes, the most common one being ischaemia due to occlusion of anterior spinal artery, which in turn is the result of a number of underlying processes. As such, the list of causative pathologies is very similar to that of acute spinal cord ischaemia syndrome.
Causes of ventral cord syndrome include 1-5:
- ischaemia/infarction (anterior spinal artery syndrome)
- external compression/damage of the anterior spinal cord
For a description of the imaging features please refer to acute spinal cord ischaemia syndrome.
Treatment and prognosis
Prognosis of anterior cord syndrome is worst among all other spinal cord injury syndromes 5. It is associated with high mortality and poor functional outcome in terms of poor recovery of motor power and coordination.
Treatment is focused on treating the primary cause of anterior spinal artery insufficiency and general supportive treatment and care.
History and etymology
The anterior cord syndrome is thought to have been initially described Schneider in 1955 in the English literature ref although there are reports of this being described by K Beck in German literature in 1952 4.
- 1. McKinley W, Santos K, Meade M et-al. Incidence and outcomes of spinal cord injury clinical syndromes. J Spinal Cord Med. 2007;30 (3): 215-24. Free text at pubmed - Pubmed citation
- 2. Foo D, Rossier AB. Anterior spinal artery syndrome and its natural history. Paraplegia. 1983;21 (1): 1-10. doi:10.1038/sc.1983.1 - Pubmed citation
- 3.Cheshire WP, Santos CC, Massey EW et-al. Spinal cord infarction: etiology and outcome. Neurology. 1996;47 (2): 321-30. Pubmed citation
- 4. Beck K. Das Syndrom des Verschlusses der vorderen Spinalarterie. Deutsche Zeitschrift f. Nervenheilkunde. 1952;167 (3): 164-186. doi:10.1007/BF00242756
- 5. Kunam VK, Velayudhan V, Chaudhry ZA, Bobinski M, Smoker WRK, Reede DL. Incomplete Cord Syndromes: Clinical and Imaging Review. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (4): 1201-1222. doi:10.1148/rg.2018170178 - Pubmed
- 6. Shaoping Hou, Alexander G. Rabchevsky. Autonomic Consequences of Spinal Cord Injury. (2014) Comprehensive Physiology. 4 (4): 1419. doi:10.1002/cphy.c130045 - Pubmed