Spinal cord ischemia is reduced blood flow to spinal cord tissue from vascular occlusion, systemic hypoperfusion, embolic disease, aortic disease, trauma, or procedure-associated interruption of spinal cord arterial supply. Prolonged ischemia can cause spinal cord infarction and acute noncompressive myelopathy with motor, sensory, and autonomic deficits.
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Conditions with similar clinical presentations that must be differentiated from Spinal Cord Ischemia:
name: Spinal Cord Ischemia
creation_date: "2026-05-06T03:09:02Z"
updated_date: "2026-05-06T03:44:52Z"
description: >-
Spinal cord ischemia is reduced blood flow to spinal cord tissue from
vascular occlusion, systemic hypoperfusion, embolic disease, aortic disease,
trauma, or procedure-associated interruption of spinal cord arterial supply.
Prolonged ischemia can cause spinal cord infarction and acute noncompressive
myelopathy with motor, sensory, and autonomic deficits.
category: Complex
disease_term:
preferred_term: spinal cord ischemia
term:
id: MONDO:0020688
label: spinal cord ischemia
parents:
- Stroke disorder
synonyms:
- Ischemic myelopathy
- Spinal cord infarction
epidemiology:
- name: Rare and likely underrecognized spinal cord stroke
description: >-
Spinal cord infarction is a rare vascular event and the available
epidemiology is incomplete, with diagnostic underrecognition likely because
acute ischemic myelopathy can mimic other acute and subacute myelopathies.
evidence:
- reference: DOI:10.3390/jcm14041293
reference_title: "Spinal Cord Infarction: Clinical and Neuroradiological Clues of a Rare Stroke Subtype"
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Spinal cord infarction (SCI) of arterial origin is a rare vascular event,
and its incidence is probably underestimated.
explanation: This clinical-neuroradiology review supports rarity, uncertain incidence, and likely underrecognition.
pathophysiology:
- name: Spinal arterial supply disruption
description: >-
Aortic pathology, vertebral or aortic dissection, arteriosclerosis,
embolism, systemic hypotension, perioperative interruption of collateral
supply, or rarer embolic mechanisms can reduce spinal cord perfusion and
initiate hypoxic-ischemic injury.
cell_types:
- preferred_term: endothelial cell
term:
id: CL:0000115
label: endothelial cell
locations:
- preferred_term: spinal cord
term:
id: UBERON:0002240
label: spinal cord
- preferred_term: anterior spinal artery
term:
id: UBERON:0005431
label: anterior spinal artery
biological_processes:
- preferred_term: response to hypoxia
modifier: INCREASED
term:
id: GO:0001666
label: response to hypoxia
evidence:
- reference: PMID:25398656
reference_title: "Spinal cord ischemia: aetiology, clinical syndromes and imaging features."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Aetiologies of infarcts were arteriosclerosis of the aorta and vertebral
arteries (23.6%), aortic surgery or interventional aneurysm repair (11%)
and aortic and vertebral artery dissection (11%), and in 23.6%, aetiology
remained unclear.
explanation: This cohort review identifies major vascular and procedure-related etiologies.
- reference: DOI:10.3390/jcm14041293
reference_title: "Spinal Cord Infarction: Clinical and Neuroradiological Clues of a Rare Stroke Subtype"
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Several etiologies can be considered, considering traditional vascular
risk factors and diseases affecting the aorta and its main branches
explanation: This review supports vascular risk and aortic disease as major etiologic contexts.
downstream:
- target: Anterior horn and spinal tract ischemic injury
description: Persistent perfusion failure injures gray matter neurons and spinal tracts.
- name: Anterior horn and spinal tract ischemic injury
description: >-
Hypoxic-ischemic injury often involves anterior spinal artery territory
structures, damaging motor neurons and long tracts that mediate acute motor,
sensory, and autonomic deficits.
cell_types:
- preferred_term: motor neuron
term:
id: CL:0000100
label: motor neuron
locations:
- preferred_term: spinal cord
term:
id: UBERON:0002240
label: spinal cord
biological_processes:
- preferred_term: response to hypoxia
modifier: INCREASED
term:
id: GO:0001666
label: response to hypoxia
evidence:
- reference: PMID:37456462
reference_title: Incomplete Anterior Spinal Artery Syndrome Responsive to Intrathecal Baclofen.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Anterior cord syndrome (ACS) occurs as a result of ischemia in the
territory of the anterior spinal artery (ASA).
explanation: This directly links anterior spinal artery territory ischemia to an anterior cord ischemic syndrome.
- reference: PMID:37456462
reference_title: Incomplete Anterior Spinal Artery Syndrome Responsive to Intrathecal Baclofen.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
the underlying neural structures responsible for these symptoms include
the corticospinal tracts and anterior horns, anterolateral spinothalamic
tracts, and lateral horns, respectively.
explanation: This anterior-spinal-artery syndrome report links tract and horn anatomy to motor, sensory, and autonomic manifestations.
phenotypes:
- category: Neurological
name: Paraplegia or paraparesis
diagnostic: true
description: Acute lower-extremity weakness is a core manifestation of spinal cord ischemia and infarction.
frequency: OCCASIONAL
phenotype_term:
preferred_term: Paraplegia/paraparesis
term:
id: HP:0010551
label: Paraplegia/paraparesis
evidence:
- reference: PMID:12483181
reference_title: Anterior spinal artery syndrome after infrarenal abdominal aortic surgery.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Neurological complications such as paraplegia or paraparesis due to spinal
cord ischemia has been an unpredictable, devastating event after infrarenal
abdominal aortic surgery.
explanation: This directly supports paraplegia or paraparesis as a spinal cord ischemia manifestation.
- reference: PMID:37456462
reference_title: Incomplete Anterior Spinal Artery Syndrome Responsive to Intrathecal Baclofen.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The typical presentation of an ASA stroke is paraparesis or paraplegia
explanation: This supports lower-extremity paralysis or paresis as a common anterior spinal arterial-territory manifestation.
- category: Neurological
name: Hemiplegia or hemiparesis
diagnostic: true
description: >-
Hemiplegia or hemiparesis can occur when spinal cord infarction affects an
asymmetric sulcal-artery or hemicord vascular territory.
phenotype_term:
preferred_term: Hemiplegia/hemiparesis
term:
id: HP:0004374
label: Hemiplegia/hemiparesis
evidence:
- reference: PMID:40104967
reference_title: Unilateral Weakness Caused By Spinal Cord Infarction in a Renal Transplant Recipient.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
However, unilateral hemiparesis can occur if the sulcal artery is involved.
explanation: This explicitly supports unilateral hemiparesis as a clinical presentation of spinal cord infarction.
- category: Neurological
name: Tetraplegia
diagnostic: true
description: >-
Tetraplegia can occur with cervical or extensive spinal cord ischemic
lesions.
phenotype_term:
preferred_term: Tetraplegia
evidence:
- reference: PMID:39020288
reference_title: Weaning failure due to isolated residual diaphragmatic paralysis after cervical spinal cord ischemia following aortic surgery- a case report.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
This is, to our knowledge, the first documented instance of a patient
fully recovering from tetraplegia due to SCI while still exhibiting
ongoing bilateral diaphragmatic paralysis.
explanation: This explicitly supports tetraplegia as a manifestation of spinal cord ischemia; no specific HPO binding was used because HP:0003300 is not tetraplegia.
- category: Respiratory
name: Respiratory dysfunction
description: >-
Respiratory dysfunction can occur in spinal cord ischemia, particularly with
cervical or extensive lesions.
phenotype_term:
preferred_term: Respiratory failure
term:
id: HP:0002878
label: Respiratory failure
evidence:
- reference: PMID:39020288
reference_title: Weaning failure due to isolated residual diaphragmatic paralysis after cervical spinal cord ischemia following aortic surgery- a case report.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Bilateral diaphragmatic dysfunction can lead to dyspnea and recurrent
respiratory failure. In rare cases, it may result from high cervical
spinal cord ischemia (SCI) due to anterior spinal artery syndrome (ASAS).
explanation: This supports respiratory failure from diaphragmatic dysfunction in high cervical spinal cord ischemia.
- category: Neurological
name: Hyperacute onset to neurologic nadir
diagnostic: true
description: Rapid onset and progression to maximal deficit is a key clinical clue for ischemic myelopathy.
phenotype_term:
preferred_term: Rapid progression
temporality: ACUTE
evidence:
- reference: DOI:10.3390/jcm14041293
reference_title: "Spinal Cord Infarction: Clinical and Neuroradiological Clues of a Rare Stroke Subtype"
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The strongest predictor of SCI diagnosis is a clinical variable, i.e., a
time to nadir of severe deficits < 12 h.
explanation: This review directly supports rapid nadir as a diagnostic clinical feature.
- category: Neurological
name: Dissociated pain and temperature sensory loss
diagnostic: true
description: Spinothalamic tract involvement can produce impaired pain and temperature sensation.
phenotype_term:
preferred_term: Impaired pain sensation
term:
id: HP:0007328
label: Impaired pain sensation
evidence:
- reference: PMID:30093205
reference_title: "Spinal Cord Infarction: Clinical and Radiological Features."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Clinical presentation included dissociative anesthesia, weakness of limbs,
back or neck pain, and autonomic symptoms
explanation: This spinal cord infarction case series supports dissociated sensory impairment as part of the presentation.
- reference: PMID:37456462
reference_title: Incomplete Anterior Spinal Artery Syndrome Responsive to Intrathecal Baclofen.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
bilateral loss of pain and temperature sensation
explanation: This anterior-spinal-artery syndrome report supports the pain-temperature sensory pattern.
- category: Musculoskeletal
name: Acute back or neck pain
description: Acute axial pain commonly accompanies onset and helps distinguish ischemic myelopathy from slower inflammatory myelopathies.
phenotype_term:
preferred_term: Back pain
term:
id: HP:0003418
label: Back pain
temporality: ACUTE
evidence:
- reference: PMID:30093205
reference_title: "Spinal Cord Infarction: Clinical and Radiological Features."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Clinical presentation included dissociative anesthesia, weakness of limbs,
back or neck pain, and autonomic symptoms
explanation: This spinal cord infarction series supports back or neck pain as a presenting feature.
- category: Neurological
name: Neuropathic or radicular pain
description: >-
Neuropathic, radicular, or spinal pain is a common accompanying symptom in
spinal cord infarction; the Falcon synthesis reports pain in 68.6% in the
2024 review.
frequency: FREQUENT
phenotype_term:
preferred_term: Pain
term:
id: HP:0012531
label: Pain
evidence:
- reference: PMID:30093205
reference_title: "Spinal Cord Infarction: Clinical and Radiological Features."
supports: PARTIAL
evidence_source: HUMAN_CLINICAL
snippet: >-
Clinical presentation included dissociative anesthesia, weakness of limbs,
back or neck pain, and autonomic symptoms
explanation: This supports pain as part of spinal cord infarction presentation; the 2024 Falcon-summarized review reports a higher pooled pain frequency.
- category: Genitourinary
name: Urinary incontinence
description: Autonomic pathway injury can produce bladder dysfunction.
phenotype_term:
preferred_term: Urinary incontinence
term:
id: HP:0000020
label: Urinary incontinence
evidence:
- reference: PMID:37456462
reference_title: Incomplete Anterior Spinal Artery Syndrome Responsive to Intrathecal Baclofen.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
fecal or urinary incontinence
explanation: This anterior-spinal-artery syndrome report directly supports urinary incontinence as an autonomic manifestation.
environmental:
- name: Aortic disease and aortic procedures
description: >-
Aortic disease, aortic dissection, cross-clamping, open aortic repair, and
endovascular aneurysm repair can interrupt collateral spinal cord blood
supply and precipitate ischemia.
presence: Positive
evidence:
- reference: PMID:12483181
reference_title: Anterior spinal artery syndrome after infrarenal abdominal aortic surgery.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Complete paraplegia due to ischemic spinal cord injury was thought to be
caused by interruption of critical collateral blood supply to the spinal
cord.
explanation: This supports collateral-supply interruption as a peri-aortic procedure mechanism.
- reference: PMID:11641795
reference_title: "Spinal cord infarction: prognosis and recovery in a series of 36 patients."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
there were cases associated with aortic surgery (25%), systemic
arteriosclerosis (19.4%) and acute deficit of perfusion (11.1%).
explanation: This outcome series supports aortic surgery, arteriosclerosis, and perfusion deficit as acquired contexts.
- name: Vessel dissection, embolism, and systemic hypoperfusion
description: >-
Dissection, embolism, hypercoagulability, vasculitis, decompression illness,
systemic hypotension, and global hypoperfusion are recognized acquired
contexts for spinal cord infarction.
presence: Positive
evidence:
- reference: PMID:25398656
reference_title: "Spinal cord ischemia: aetiology, clinical syndromes and imaging features."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Aetiologies of infarcts were arteriosclerosis of the aorta and vertebral
arteries (23.6%), aortic surgery or interventional aneurysm repair (11%)
and aortic and vertebral artery dissection (11%), and in 23.6%, aetiology
remained unclear.
explanation: This cohort supports vascular and dissection contexts while noting frequent unclear etiology.
- name: Fibrocartilaginous embolism in otherwise low-risk patients
description: >-
Fibrocartilaginous embolism is a rare mechanism to consider when spinal cord
infarction occurs in adult or pediatric patients without conventional
vascular risk factors.
presence: Positive
evidence:
- reference: PMID:36114979
reference_title: "Fibrocartilaginous embolism: a rare cause leading to spinal cord infarction?"
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Fibrocartilaginous embolism must be a differential diagnosis in case of
otherwise unexplained spinal cord infarction in adult and paediatric low
risk population.
explanation: This case series supports fibrocartilaginous embolism as a rare cause in low-risk patients.
diagnosis:
- name: MRI-supported spinal cord infarction diagnosis
description: >-
Acute spinal cord ischemia diagnosis depends on clinical timing, exclusion
of compression, and supportive MRI features such as diffusion restriction,
pencil-like sagittal T2 hyperintensity, anterior-horn owl-eye signal, cord
edema, or associated vertebral-body infarction.
evidence:
- reference: DOI:10.3390/jcm14041293
reference_title: "Spinal Cord Infarction: Clinical and Neuroradiological Clues of a Rare Stroke Subtype"
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
the lack of cord compression on Magnetic Resonance Imaging (MRI) is the
only mandatory feature for diagnosis.
explanation: This review supports excluding compressive myelopathy as a mandatory diagnostic step.
- reference: PMID:25398656
reference_title: "Spinal cord ischemia: aetiology, clinical syndromes and imaging features."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
MRI disclosed hyperintense pencil-like lesion pattern on T2WI in 98.2%,
cord swelling in 40%, enhancement on post-contrast T1WI in 42.9% and
always hyperintense signal on diffusion-weighted imaging (DWI) when
acquired.
explanation: This imaging cohort supports characteristic MRI patterns and DWI utility.
- reference: DOI:10.3390/jcm14041293
reference_title: "Spinal Cord Infarction: Clinical and Neuroradiological Clues of a Rare Stroke Subtype"
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Some MRI features are supportive of the diagnosis, particularly when the
anterior spinal artery territory is involved and diffusion-weighted
imaging (DWI) is used.
explanation: This review supports DWI and anterior spinal artery territory findings as supportive diagnostic features.
- name: Hyperacute clinical pattern integrated with neuroradiology
description: >-
Diagnosis is strengthened when acute noncompressive myelopathy reaches
nadir rapidly and MRI localizes the lesion to a spinal arterial territory.
evidence:
- reference: PMID:30093205
reference_title: "Spinal Cord Infarction: Clinical and Radiological Features."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Spinal cord infarction is a rare but important cause of acute spinal
syndrome. Typical distribution and appropriate imaging can help in timely
diagnosis.
explanation: This clinical-radiologic case series supports combining acute syndrome pattern with imaging distribution.
differential_diagnoses:
- name: Acute and subacute noncompressive myelopathies
description: >-
Inflammatory, demyelinating, and other acute or subacute noncompressive
myelopathies can clinically overlap with spinal cord infarction; rapid
nadir, vascular or aortic context, absence of compression, and arterial
territory MRI patterns favor ischemia.
distinguishing_features:
- Sudden onset and rapid nadir
- Focal pain adjacent to lesion
- Lack of cord compression on MRI
- DWI or anterior arterial-territory MRI support
evidence:
- reference: DOI:10.3390/jcm14041293
reference_title: "Spinal Cord Infarction: Clinical and Neuroradiological Clues of a Rare Stroke Subtype"
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
many cases may be misdiagnosed as other forms of acute and subacute
myelopathies.
explanation: This review supports acute and subacute myelopathies as the major diagnostic-mimic group.
- reference: DOI:10.3390/jcm14041293
reference_title: "Spinal Cord Infarction: Clinical and Neuroradiological Clues of a Rare Stroke Subtype"
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The strongest predictor of SCI diagnosis is a clinical variable, i.e., a
time to nadir of severe deficits < 12 h.
explanation: This supports rapid nadir as a distinguishing clinical feature from slower myelopathies.
treatments:
- name: Rehabilitation and functional recovery planning
description: >-
Management is largely supportive and rehabilitative after acute diagnosis;
prognosis depends strongly on initial neurologic severity and age.
treatment_term:
preferred_term: physical therapy
term:
id: MAXO:0000011
label: physical therapy
evidence:
- reference: PMID:11641795
reference_title: "Spinal cord infarction: prognosis and recovery in a series of 36 patients."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Assessment of functional outcome was made regarding ambulatory ability or
wheelchair use, and bladder/sphincter control.
explanation: This outcome series supports functional recovery and rehabilitation planning around ambulation and sphincter control.
- reference: PMID:11641795
reference_title: "Spinal cord infarction: prognosis and recovery in a series of 36 patients."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Acute spinal cord ischemia syndrome has a severe prognosis with permanent
and disabling sequelae.
explanation: This outcome series supports prognosis counseling and long-term supportive care.
- name: Perfusion augmentation and cerebrospinal fluid drainage in selected acute cases
description: >-
In selected acute or peri-aortic cases, raising mean arterial pressure and
lowering cerebrospinal fluid pressure may improve spinal cord perfusion, but
evidence outside perioperative protocols is limited.
treatment_term:
preferred_term: supportive care
term:
id: MAXO:0000950
label: supportive care
evidence:
- reference: PMID:30294499
reference_title: Cerebrospinal fluid drainage and blood pressure elevation to treat acute spinal cord infarct.
supports: PARTIAL
evidence_source: HUMAN_CLINICAL
snippet: >-
Lumbar CSFD with MAP elevation benefited 3 patients with acute SCI of
varying etiologies.
explanation: This small case series supports possible benefit in selected acute SCI cases while requiring cautious interpretation.
- reference: PMID:30294499
reference_title: Cerebrospinal fluid drainage and blood pressure elevation to treat acute spinal cord infarct.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Lumbar cerebrospinal fluid drainage (CSFD) with blood pressure
augmentation is utilized in the thoracic/thoracoabdominal aortic repair
and thoracic endovascular aortic repair (TEVAR) populations to increase
spinal perfusion pressure.
explanation: This supports the physiologic rationale and peri-aortic use context for CSFD plus blood pressure augmentation.
- name: Surgical decompression in selected cases
description: >-
Surgical decompression is reported in a subset of spinal cord infarction
cases and may be considered when the clinical scenario suggests a
surgically addressable compressive or decompression-responsive component.
treatment_term:
preferred_term: surgical procedure
term:
id: MAXO:0000004
label: surgical procedure
evidence:
- reference: PMID:39372971
reference_title: "Spinal cord infarction: A systematic review and meta-analysis of patient's characteristics, diagnosis accuracy, management, and outcome."
supports: PARTIAL
evidence_source: HUMAN_CLINICAL
snippet: >-
About 68.9% benefited from medical treatment and physiotherapy, whereas
spinal surgical decompression was done in 22.8%.
explanation: This systematic review documents reported use of surgical decompression while not establishing it as universally indicated.
Spinal cord infarction is described as a rare ischemic vascular lesion of the spinal cord (a “rare stroke subtype”) that presents as an acute or hyperacute myelopathy and is diagnostically challenging because early MRI (including DWI) can be normal or equivocal. (dokponou2024spinalcordinfarction pages 1-2, zedde2025spinalcordinfarction pages 10-11)
Direct abstract-supported definition (2024 systematic review): Dokponou et al. describe acute spinal cord infarction as “a rare ischemic vascular lesion” and emphasize difficulty diagnosing it in the acute phase, including that diffusion-weighted MRI may fail to show abnormalities early. (dokponou2024spinalcordinfarction pages 1-2)
Commonly used interchangeable terms in the retrieved recent literature include: - Spinal cord infarction (SCI) (dokponou2024spinalcordinfarction pages 1-2) - Spinal cord ischemia (used both for spontaneous infarction and perioperative ischemic injury) (chen2023prophylacticcerebrospinalfluid pages 1-2) - Ischemic spinal cord injury (especially perioperative/aortic contexts) (torre2025spinalcordprotection pages 10-11) - Ischemic myelopathy (historical/vascular syndromic term; identified in review literature) (dokponou2024spinalcordinfarction pages 7-8)
Within the retrieved full-text set, formal ICD-10/ICD-11, MeSH, and MONDO identifiers were not explicitly provided, and thus cannot be asserted from the evidence captured here.
For a knowledge base, spinal cord ischemia/infarction is typically mapped under spinal cord vascular disorders and/or spinal stroke; however, this report does not provide codes without direct evidence from the retrieved sources.
A 2024 systematic review/meta-analysis (876 patients) categorized etiologies as: - Vascular: 44.2% - Traumatic: 14.3% - Infectious: 6.1% - Unknown: 35.5% (dokponou2024spinalcordinfarction pages 3-5)
The same review describes etiologies as spontaneous or iatrogenic and lists common causes including aortic disease, cardioembolism, systemic hypoperfusion, vasculitis, and idiopathic causes, with atherosclerosis commonly implicated. (dokponou2024spinalcordinfarction pages 1-2)
Spinal cord ischemia is a feared complication after: - Open descending thoracic/thoracoabdominal aortic repair (nasir2023safetyofcerebrospinal pages 1-3) - Thoracic endovascular aortic repair (TEVAR) and thoracoabdominal endovascular procedures (chen2023prophylacticcerebrospinalfluid pages 1-2)
Mechanistically, these settings involve disruption of spinal cord blood supply, extensive segmental artery coverage, hypoperfusion, embolism, and ischemia–reperfusion injury (particularly after open cross-clamping). (torre2025spinalcordprotection pages 1-2, nasir2023safetyofcerebrospinal pages 6-7)
A 2025 review summarizing cohort evidence reported common vascular risk factors in SCI as: - Hypertension ~40% - Smoking ~30% - Dyslipidemia ~29% - Diabetes ~16% - ~28% without reported vascular risk factors (zedde2025spinalcordinfarction pages 2-4)
However, in the 2024 systematic review/meta-analysis dataset, recorded cardiovascular risk factors were often absent: 66.1% had no recorded cardiovascular risk factors, with hypertension 17.1% and hypertension+diabetes 6.2% among those reported. (dokponou2024spinalcordinfarction pages 3-5)
For TEVAR, risk is increased by procedure- and anatomy-related factors, including extent of aortic coverage and collateral vessel occlusion; a meta-analysis notes reported TEVAR SCI rates range 0–17% in literature, with highest rates in thoracoabdominal aneurysm procedures. (chen2023prophylacticcerebrospinalfluid pages 1-2)
The retrieved evidence is strongest for perioperative protective strategies (rather than host protective factors). Key physiology-guided protective principle: maintaining spinal cord perfusion pressure (SCPP) by supporting arterial pressure and reducing CSF pressure when needed. (torre2025spinalcordprotection pages 10-11, nasir2023safetyofcerebrospinal pages 6-7)
No gene–environment interaction evidence specific to spinal cord ischemia/infarction was identified in the retrieved sources.
From a 2025 clinical-neuroradiological review synthesis: - Motor deficits: 92% - Sensory deficits: 85% - Autonomic dysfunction: 76% - Pain: 70% (zedde2025spinalcordinfarction pages 6-8)
From a 2024 systematic review/meta-analysis (876 patients), pooled phenotype frequencies included: - Hemiplegia 23.2% - Paraplegia 21.7% - Tetraplegia 14.8% - Paraparesis 8.9% - Respiratory dysfunction 11.9% - Swallowing disturbance 7.6% - Asymptomatic 11.9% (dokponou2024spinalcordinfarction pages 3-5)
Pain (including radicular/spinal pain) was reported in 68.6% in the 2024 review’s synthesis. (dokponou2024spinalcordinfarction pages 7-8)
Time to nadir (time from onset to maximal deficit) is a key discriminator for diagnosis. - 2024 meta-analysis: <6 h (56.1%), 6–12 h (30.7%), 12–72 h (5.4%), >72 h (7.8%). (dokponou2024spinalcordinfarction pages 3-5) - 2025 review synthesis: pooled data suggesting ~81% reach nadir within 12 h (with an additional breakdown in some syntheses), supporting a hyperacute pattern typical of spinal cord infarction. (zedde2025spinalcordinfarction pages 8-10)
Based on the reported phenotypes: - Paraplegia (HP:0003401) / Paraparesis (HP:0001258) / Tetraplegia (HP:0003300) (dokponou2024spinalcordinfarction pages 3-5) - Sensory impairment (HP:0003401 is motor; for sensory: consider HP:0000769 abnormality of sensation; map more precisely to pain/temperature loss when curated) (zedde2025spinalcordinfarction pages 6-8) - Neuropathic pain (HP:0007018) / Pain (HP:0012531) (zedde2025spinalcordinfarction pages 6-8) - Autonomic dysfunction (HP:0002459) including bladder dysfunction (HP:0000010) (dokponou2024spinalcordinfarction pages 7-8) - Dysphagia (HP:0002015) (dokponou2024spinalcordinfarction pages 3-5) - Respiratory distress/failure (HP:0002098) (dokponou2024spinalcordinfarction pages 3-5)
(Exact HPO IDs should be validated during knowledge base curation; the above are suggested mappings consistent with the phenotype descriptions.)
Spinal cord ischemia/infarction is not primarily a monogenic disorder in the retrieved evidence, and no specific causal genes/variants were identified.
1) Upstream triggers - Arterial occlusion/embolism, aortic disease/dissection, vertebral artery dissection, systemic hypoperfusion/hypotension, perioperative segmental artery coverage or cross-clamping (dokponou2024spinalcordinfarction pages 1-2, torre2025spinalcordprotection pages 1-2)
2) Perfusion failure and threshold physiology - Spinal cord perfusion pressure (SCPP) is conceptualized as MAP − CSF pressure; lowering intrathecal CSF pressure (e.g., via CSF drainage) and/or raising MAP can increase SCPP. (nasir2023safetyofcerebrospinal pages 6-7, torre2025spinalcordprotection pages 10-11)
3) Tissue vulnerability and vascular territories - Anterior spinal artery (ASA) territory ischemia affects anterior horns/corticospinal/spinothalamic pathways, producing motor deficits, pain/temperature loss, and autonomic dysfunction; posterior spinal artery involvement more strongly affects vibration/proprioception modalities. (zedde2025spinalcordinfarction pages 6-8)
4) Downstream molecular injury cascades In aortic-surgery focused synthesis, secondary injury mechanisms include: - Glutamate excitotoxicity - Oxidative stress / reactive oxygen species (ROS) - Mitochondrial dysfunction - Blood–spinal cord barrier disruption - Inflammation - Calcium influx These are highlighted especially for ischemia–reperfusion contexts (open repair) and for sustained hypoperfusion contexts (TEVAR). (torre2025spinalcordprotection pages 1-2, torre2025spinalcordprotection pages 2-4)
Spinal cord ischemia/infarction is most strongly linked in the retrieved evidence to: - Iatrogenic/surgical exposures (open aortic repair, TEVAR) (chen2023prophylacticcerebrospinalfluid pages 1-2, nasir2023safetyofcerebrospinal pages 1-3) - Hemodynamic exposures (hypotension/hypovolemia as hypoperfusion drivers) (torre2025spinalcordprotection pages 2-4)
No specific toxin/pollution/occupational exposures were identified in the retrieved sources.
Aortic-surgery focused synthesis emphasizes the collateral network concept for cord perfusion (segmental arteries plus proximal/distal contributors), and notes two injury patterns: - Ischemia–reperfusion injury (more typical after open repair/cross-clamping) - Sustained hypoperfusion/energy failure (typical of TEVAR due to segmental artery coverage) (torre2025spinalcordprotection pages 2-4)
A prospective observational cohort (TURBO; NCT04523909) leverages standard-of-care lumbar drains to measure perioperative CSF inflammatory markers (e.g., IL6, IL8, IL10, MCP-1) and neural injury markers (NFL, S100B, GFAP, UCHL1, NSE), aiming to characterize neuroinflammatory trajectories in thoracic aortic surgery patients. (NCT04523909 chunk 1)
Given oxidative stress/mitochondrial dysfunction emphasis, mitochondrion (GO:0005739) is a plausible key compartment for injury cascades in ischemia–reperfusion contexts. (torre2025spinalcordprotection pages 2-4)
Functional outcomes can improve substantially in aggregate: Dokponou et al. report median mRS improving from 3 at admission to 1 at ~12 months in pooled data. (dokponou2024spinalcordinfarction pages 1-2)
A 2025 review synthesis reports: - SCI estimated at ~1–2% of all strokes and 5–8% of acute myelopathies - Population incidence estimates ~1.5–3.1 per 100,000 person-years (zedde2025spinalcordinfarction pages 2-4)
A 2024 systematic review reiterates rarity and estimates ~0.3–1% of all strokes. (dokponou2024spinalcordinfarction pages 1-2)
A 2023 meta-analysis (40 studies; n=4,793) estimated pooled TEVAR spinal cord ischemia incidence: - Overall 3.5% (95% CI 2.6–4.4) - Immediate 1.3% - Delayed 1.9% (chen2023prophylacticcerebrospinalfluid pages 6-7)
For TEVAR in type B aortic dissection specifically, a 2024 systematic review (34 studies; n=2,749) reported pooled permanent SCI 2.0% (95% CI 1.0–3.0) and temporary SCI 1.0% (95% CI 0.0–1.0). (zheng2024systematicreviewof pages 1-2)
A 2025 review emphasizes that MRI is central but may be negative early; DWI can help but is imperfect. - Initial MRI abnormal in ~75% (review synthesis), yet up to ~50% of T2 images may be negative within 24 h and a material fraction can have normal initial MRI despite severe deficits. (zedde2025spinalcordinfarction pages 8-10) - DWI is recommended with ADC confirmation; DWI restriction often appears early (reported from the third hour) and ADC may normalize after ~7 days. (zedde2025spinalcordinfarction pages 10-11)
Typical MRI patterns: - Axial “owl’s eyes” sign (central gray matter) and sagittal “pencil-like” anterior cord hyperintensity (zedde2025spinalcordinfarction pages 8-10) - In one pooled dataset, owl’s-eye T2 finding was reported in 48.2% (dokponou2024spinalcordinfarction pages 3-5)
Recommended acute workup in suspected infarction includes emergent CTA chest/abdomen to exclude aortic pathology followed by ischemia-sensitive spinal MRI sequences (DWI/ADC). (zedde2025spinalcordinfarction pages 8-10)
CSF is typically non-inflammatory, reported as non-inflammatory in 92% in review synthesis. (zedde2025spinalcordinfarction pages 6-8)
Important mimics include compressive causes such as spinal epidural or intramedullary hematoma (cord compression). (dokponou2024spinalcordinfarction pages 1-2)
In pooled data, functional improvement over months is common: - Median mRS improved from 3 at admission to 1 at ~12 months (Dokponou 2024 synthesis). (dokponou2024spinalcordinfarction pages 1-2)
In open aortic repair series with CSF drainage (n=132), in-hospital mortality was 7.6%. (nasir2023safetyofcerebrospinal pages 1-3)
In the 2024 pooled analysis, the most common management was medical treatment plus physiotherapy (68.9%), with surgical decompression used in 22.8%. (dokponou2024spinalcordinfarction pages 3-5)
MAXO suggestions (to be validated in ontology mapping): - Rehabilitation therapy / physiotherapy - Supportive care - Surgical decompression (when indicated by compressive pathology or selected cases)
Core principle: preserve spinal cord perfusion pressure and collateral circulation. - SCPP concept: SCPP = MAP − CSF pressure (nasir2023safetyofcerebrospinal pages 6-7) - Strategies: CSF drainage, permissive/induced hypertension, distal aortic perfusion, staged repair, neuromonitoring, collateral preservation/revascularization. (torre2025spinalcordprotection pages 1-2, torre2025spinalcordprotection pages 18-18)
In open DTAA/TAAA repair series (Nasir 2023), permanent paraplegia was 3.0% with routine CSF drainage, with CSF drain complications 19% overall (mostly minor) but including serious hemorrhagic events. (nasir2023safetyofcerebrospinal pages 1-3, nasir2023safetyofcerebrospinal pages 6-7)
A 2025 expert review summarizes that guideline support is strongest for open TAAA and more conditional for high-risk endovascular procedures (e.g., EACTS/STS 2024 strong recommendation for open TAAA; consider prophylactic drainage for high-risk endovascular cases). (torre2025spinalcordprotection pages 10-11)
MAXO suggestions (perioperative aortic contexts): - Cerebrospinal fluid drainage - Blood pressure management / induced hypertension - Distal aortic perfusion - Intraoperative neuromonitoring - Endovascular aortic repair / open aortic repair (procedure ontology mapping)
Not applicable in the conventional public-health sense for spontaneous SCI due to heterogeneous etiologies and rarity; prevention focuses on general vascular risk reduction (hypertension/smoking management) and surgical risk mitigation.
In aortic surgery, prevention is protocol-driven, emphasizing physiologic protection (SCPP optimization) and rapid rescue because the window to reverse deficits may be short (often discussed as 1–2 hours in expert synthesis). (torre2025spinalcordprotection pages 10-11)
No naturally occurring veterinary syndrome was identified in the retrieved sources; the animal evidence primarily concerns induced experimental models.
A systematic review of preclinical aortic cross-clamping models reports use of: - Mouse, rat, rabbit, dog, pig, baboon, sheep (awad2021histologicalfindingsafter pages 1-2)
A review of models emphasizes that ischemia duration needed for paralysis scales by species (mice ~9–11 min; dogs/pigs ~45–60 min), and that vascular anatomy differences (e.g., artery of Adamkiewicz/radiculomedullary supply) influence reproducibility and translational validity. (awad2013animalmodelsof pages 20-22, awad2013animalmodelsof pages 1-4)
Across cross-clamp models, injury is predominantly in gray matter, though white matter injury can occur. (awad2021histologicalfindingsafter pages 1-2)
The 2024 systematic review/meta-analysis provides consolidated, quantitative evidence on time-to-nadir, phenotype distributions, imaging signs (owl’s-eye), management patterns, and mRS improvement. (dokponou2024spinalcordinfarction pages 3-5, dokponou2024spinalcordinfarction pages 1-2)
2023–2024 evidence syntheses converge on a key controversy: routine prophylactic CSF drainage has not shown clear pooled benefit in TEVAR, while carrying non-trivial complication risks; selective/high-risk approaches and protocol standardization remain active areas. (chen2023prophylacticcerebrospinalfluid pages 6-7, zheng2024systematicreviewof pages 1-2)
| Topic | Citation (authors, year) | PMID/DOI | Publication date (month/year) | Key quantitative findings | Key conclusion/implication | URL |
|---|---|---|---|---|---|---|
| Spontaneous spinal cord infarction / general SCI overview | Dokponou et al., 2024 | DOI: 10.25259/sni_477_2024 | 09/2024 | Systematic review of 117 articles/876 patients; mean age 51.1 ± 19.4 years; 64.4% male; acute spinal cord infarction estimated at ~0.3–1% of all strokes; time to nadir: <6 h 56.1%, 6–12 h 30.7%, 12–72 h 5.4%, >72 h 7.8%; MRI alone used in 64.4%; “owl’s eye” sign 48.2%; T2DWI AUC 0.835 for hyperacute detection; 68.9% received medical therapy + physiotherapy, 22.8% surgical decompression; median mRS improved from 3 at admission to 1 at ~12 months; mortality 13.4% (dokponou2024spinalcordinfarction pages 3-5, dokponou2024spinalcordinfarction pages 1-2, dokponou2024spinalcordinfarction pages 2-3) | Rare ischemic myelopathy with hyperacute presentation in most cases; MRI/DWI are helpful but imperfect early; outcomes can improve substantially with diagnosis, supportive care, and rehabilitation. | https://doi.org/10.25259/sni_477_2024 |
| Spontaneous spinal cord infarction / epidemiology and incidence | Zedde et al., 2025 | DOI: 10.3390/jcm14041293 | 02/2025 | Review estimates SCI at ~1–2% of all strokes and 5–8% of acute myelopathies; population incidence ~1.5–3.1 per 100,000 person-years; about 8% in multilevel aortic disease; prevalence may reach up to 33% after thoraco-abdominal aortic surgery; typical age 6th–7th decades; vascular risk factors reported: hypertension 40%, smoking 30%, dyslipidemia 29%, diabetes 16%; ~28% lacked reported vascular risks (zedde2025spinalcordinfarction pages 2-4, zedde2025spinalcordinfarction pages 18-20) | SCI is probably under-recognized; rapid onset-to-nadir (<12 h) is a strong diagnostic clue, and epidemiologic burden is likely underestimated. | https://doi.org/10.3390/jcm14041293 |
| TEVAR / prophylactic CSF drainage meta-analysis | Chen et al., 2023 | DOI: 10.21037/acs-2023-scp-17 | 09/2023 | Meta-analysis of 40 studies/4,793 TEVAR patients; pooled SCI incidence 3.5% (95% CI 2.6–4.4), immediate SCI 1.3%, delayed SCI 1.9%; no significant difference with CSFD vs no CSFD for any SCI (OR 1.34, 95% CI 0.88–2.04), transient SCI (OR 1.84, 95% CI 0.95–3.54), or permanent SCI (OR 1.25, 95% CI 0.47–3.30); selective CSFD associated with increased transient SCI (OR 2.08, 95% CI 1.06–4.08); CSFD complications: spinal headache 4.3%, major complications 1.6%, epidural/spinal hematoma 0.9%, intracranial/subdural hemorrhage 0.8%, death 0.6%; perioperative mortality 1.7%, mid-term mortality 4.5% (chen2023prophylacticcerebrospinalfluid pages 1-2, chen2023prophylacticcerebrospinalfluid pages 6-7, chen2023prophylacticcerebrospinalfluid pages 10-14) | In endovascular thoracic/thoracoabdominal repair, prophylactic CSFD has not shown clear pooled benefit for reducing SCI and is not benign; patient selection and protocol standardization remain important. | https://doi.org/10.21037/acs-2023-scp-17 |
| TEVAR for type B aortic dissection / CSF drainage systematic review | Zheng et al., 2024 | DOI: 10.1186/s13019-024-02603-3 | 03/2024 | Systematic review of 34 studies/2,749 patients; pooled permanent SCI 2.0% (95% CI 1.0–3.0); temporary SCI 1.0% (95% CI 0.0–1.0); no significant difference in permanent SCI with prophylactic CSFD vs none (2.0% vs 2.0%; P=0.445); no difference between routine vs selective CSFD (P=0.596); 30-day/in-hospital mortality 4.0% with prophylactic CSFD vs 5.0% without (P=0.525); mean Downs and Black score 8.71 (zheng2024systematicreviewof pages 5-7, zheng2024systematicreviewof pages 2-5, zheng2024systematicreviewof pages 1-2) | For TEVAR in type B aortic dissection, pooled nonrandomized data do not support a reduction in permanent SCI or short-term mortality from prophylactic CSFD. | https://doi.org/10.1186/s13019-024-02603-3 |
| Open descending thoracic/thoracoabdominal aortic repair / CSF drainage safety | Nasir et al., 2023 | DOI: 10.21037/acs-2023-scp-0121 | 09/2023 | Single-center 17-year series, n=132 with routine CSFD; in-hospital mortality 7.6%; transient paresis 3.8%; permanent paraplegia 3.0%; CSFD complications 19% overall, including persistent CSF leak 7%, blood-tinged CSF 11%, subdural hematoma in 3 patients, spinal cutaneous fistula 1%; survival 86.4% at 1 year, 75.2% at 5 years, 50.9% at 15 years; ACC/AHA recommendation cited as Class I, Level A for open TAAA repair (nasir2023safetyofcerebrospinal pages 1-3, nasir2023safetyofcerebrospinal pages 4-6, nasir2023safetyofcerebrospinal pages 6-7, nasir2023safetyofcerebrospinal pages 3-4) | In open DTAA/TAAA repair, CSFD remains a commonly used protective adjunct with accepted complication risk; evidence and guidelines are stronger here than for TEVAR. | https://doi.org/10.21037/acs-2023-scp-0121 |
| Guideline/review synthesis for aortic-surgery spinal cord protection | Torre & Pirri, 2025 | DOI: 10.3389/fcvm.2025.1671350 | 09/2025 | Review cites randomized open TAAA data showing paraplegia/paraparesis 13% without vs 2.6% with CSFD; states 2024 EACTS/STS strongly recommend CSFD for open TAAA replacement (Class I, Level B) and advise considering prophylactic drainage for high-risk endovascular cases (Class IIa, Level C); also notes insufficient evidence for routine prophylactic drainage in endovascular procedures (torre2025spinalcordprotection pages 10-11) | Current expert guidance supports CSFD most strongly for open TAAA repair, while high-risk TEVAR decisions should be individualized within bundled spinal cord protection strategies. | https://doi.org/10.3389/fcvm.2025.1671350 |
| Trial: prophylactic vs therapeutic drain strategy in endovascular TAAA repair | NCT04941157 | 2022 (registry record) | Randomized pilot interventional study; enrollment 20; compares prophylactic CSF drain placement before high-risk endovascular thoracoabdominal aneurysm repair vs selective/therapeutic placement only if SCI develops; primary outcome: rate of postoperative spinal cord ischemia over 1 year, defined as new lower-extremity neurologic deficit, assessed with Muscle Power Scale (NCT04941157 chunk 2, NCT04941157 chunk 1) | Directly addresses a major unresolved clinical question: whether pre-emptive drain placement improves neurologic outcomes enough to justify drain-related risk. | https://clinicaltrials.gov/study/NCT04941157 | |
| Trial: ketamine during TEVAR patients receiving naloxone continuous infusion for SCI prophylaxis | NCT04600089 | 2020 (registry record) | Phase 2 randomized double-blind placebo-controlled trial; enrollment 30; ketamine infusion 0.2 mg/kg/h vs saline for 48 h in TEVAR patients receiving naloxone continuous infusion for spinal ischemia prophylaxis; primary outcome cumulative opioid dose over 48 h; secondary outcomes pain scores, delirium (CAM-ICU), uncontrolled hypertension (NCT04600089 chunk 1) | Tests an analgesic strategy within an SCI-prevention bundle, addressing the pain/opioid burden introduced by naloxone-based prophylaxis rather than SCI efficacy directly. | https://clinicaltrials.gov/study/NCT04600089 | |
| Trial: CSF neuroinflammatory biomarkers around thoracic aortic surgery | NCT04523909 | 2017 (registry record) | Prospective observational cohort; enrollment 100; serial CSF and blood sampling across 9 perioperative timepoints to measure IL6, IL8, IL10, MCP-1, IL1RA, CX3CL1 and markers including NFL, S100B, GFAP, UCHL1, NSE; lumbar drain placed as standard care to reduce periprocedural spinal cord ischemia risk (NCT04523909 chunk 1) | Important translational study for biomarker discovery and mechanistic monitoring; may inform future prediction of perioperative neurologic injury, though it is not an intervention trial for SCI prevention. | https://clinicaltrials.gov/study/NCT04523909 |
Table: This table summarizes recent core evidence on spontaneous spinal cord infarction and perioperative spinal cord ischemia prevention in aortic surgery. It highlights incidence estimates, imaging and outcome data, CSF drainage meta-analyses, guideline interpretations, and ongoing clinical trial directions.
Chen et al. (2023) provides forest plots and tables summarizing CSF drainage vs no drainage outcomes and complication rates; these were retrieved as cropped figure/table images, including the main results table, forest plots, and CSF-drain complication table. (chen2023prophylacticcerebrospinalfluid media cf49819c, chen2023prophylacticcerebrospinalfluid media 628d27e4, chen2023prophylacticcerebrospinalfluid media 3b07512f, chen2023prophylacticcerebrospinalfluid media 2ef757c8, chen2023prophylacticcerebrospinalfluid media 0f2ce663)
References
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