CT Angiography Of Anterior Spinal Artery In Patients With Cervical Spinal Cord Injury And Cervical Spondylotic Myelopathy

Background: Spinal cord injury(SCI) including primary injury and secondary injury,and ischemia is one of the main mechanisms for secondary spinal cord injury. After theoccurrence of primary injury of spinal cord, ischemia alone or collaborative other factorspromoted the progress of the secondary damage of spinal cord, which caused nerve celldysfunction and eventually death. Spinal cord ischemia patients paralyzed rate reaches ashigh as33%. Anterior spinal artery syndrome (ASAS) is one type of the most commonspinal vascular lesions. The diagnosis of ASAS is often according to its clinicalcharacteristics and MRI; however, MRI could not provide intuitionistic imaging material.Cervical spondylotic myelopathy(CSM) is characters with spinal cord compression, sosome clinical spinal cord injury performance, and high signal area of MRI T2phase. Thiskind of high signal area is considered spinal cord ischemia and necrosis place, which maybe affect the prognosis of patients. It may also be related with spinal cord ventral artery, butno exact evidence.Anterior spinal artery (ASA) walks in the middle of the spinal cord ventral groove,covers the whole spinal cord, and supplies the two-thirds of spinal cord. ASA plays animportant role in the supply of blood for spinal cord. Some authors think that posttraumaticcervical spinal cord injury may be related with the damaged ASA, which caused spinal cordhemorrhagic necrosis and myelomalacia.The relationships between ASA and the traumatic cervical spinal cord injury, ASA andMRI images T2high signal area in CSM, are our research interests. So spinal cord ventralartery image through a non-invasive way was considered.In our experiments, CT angiography(CTA) of anterior spinal artery in18cases oftraumatic cervical spinal cord injury patients and17cases of CSM patients was observed.The valuation of CTA in detecting the ASA, the relationship between ASA and traumatic cervical SCI, and correlation between spinal cord compression and MRI images T2highsignal area in CSM, were investigated.Objective: To observe ASA injury and infarct in18cases of traumatic cervical SCIpatients and17cases of CSM patients through CTA of cervical ASA.Method：Patients: From January2008to August2012，18cases of traumatic cervicalSCI patients and17cases of CSM patients were introduced for CTA of cervical ASA. Thecervical SCI patients included16cases of male and2cases of female, with average age of49.7years (16-73years). The injury types included10cases of falling injury,7cases oftraffic accident injury, and one cases of knife assault. There were9cases of central cordsyndrome,3cases of Brown-Sequard syndrome, and6cases of tetraplegia (ASIA A). TheCSM patients included14cases of male and3cases of female, with average age of49.4years (31-80years). There were2cases of CSM combined with ASAS and15cases ofCSM, including12cases of abnormal T2high signal in MRI. For the levels of myelopathy,10cases showed single segmental level and7cases of multi-segmental levelsCTA: CT angiography of ASA was performed with64-row MDCT scanners, the imagewas generated with ADW4.3software, and the relationship of the vessels and surroundingstructure with MPR was observed;ASA observation: The the sagittal position and the coronal position of the CTAimages were estimated whether the ASA were interrupted, injured and infracted.Follow-up: The patients and their family members were trained to master the way toexamine the strength and feel of patients before discharge. Every patient followed up atexact time points or made a call recording if unconvinced for hospital.Results: The ASA was visualized in all18cervical SCI patients. Only the knifeassault case showed ASA was interrupted. After6to13months follow-up,6cases oftetraplegia did not show neurological improvement, while9cases of CCS and3cases ofBSS patients were improved one grade of ASIA scale.The ASA interruption was only found in2cases of ASAS combined CSM. After0.5to12months follow-up,1case of ASAS patients neurologically improved from ASIS C to Dtwo weeks after the decompression surgery, while the other ASAS patient did not showimprovement with12month followed-up. For other12CSM patients with surgicaldecompression,10cases improved from ASIA D to E,2cases had no improvement. For3 cases of CSM without operation, two of them showed worse neurological symptoms and theother one with no obvious change.Conclusions:1. The cervical ASA can be visualized by64-row CTA in patients withtrauma cervical SCI.2. The cervical ASA is not easy to be injured in the trauma cervical SCI patients.3. Hemorrhage and ischemia of spinal cord after trauma injury have no directrelationship with cervical ASA.4.64-row CTA can identify the cervical ASA infarct in CSM combine ASAS patients.5. The cervical ASA cannot be easily infarct in the CSM, even with severely cordcompression.6. The high signal area in the MRI T2phase of the CSM patients have no directrelationship with cervical ASA...