Myelopathy selectively involving the lower extremities can occur secondary to spondylotic changes, tumor, vascular malformations, or thoracolumbar cord ischemia. Vascular causes of myelopathy are rarely described. An uncommon etiology within this category is diaphragmatic crus syndrome, in which compression of an intersegmental artery supplying the cord leads to myelopathy. The authors present the operative technique for treating this syndrome, describing their experience with 3 patients treated for acute-onset lower-extremity myelopathy secondary to hypoperfusion of the anterior spinal artery.
All patients had compression of a lumbar intersegmental artery supplying the cord; the compression was caused by the diaphragmatic crus. Compression of the intersegmental artery was probably producing the patients’ symptoms by decreasing blood flow through the artery of Adamkiewicz, causing lumbosacral ischemia.
All patients underwent surgery to transect the offending diaphragmatic crus. Each patient experienced substantial symptom improvement, and 2 patients made a full neurological recovery before discharge.
Diaphragmatic crus syndrome is a rare or under-recognized cause of ischemic myelopathy. Patients present with episodic acute-on-chronic lower-extremity paraparesis, gait instability, and numbness. Angiography confirms compression of an intersegmental artery that gives rise to a dominant radiculomedullary artery. Transecting the offending diaphragmatic crus can produce complete resolution of neurological symptoms.
Correspondence Nicholas Theodore: Johns Hopkins School of Medicine, Baltimore, MD. firstname.lastname@example.org.INCLUDE WHEN CITING Published online March 20, 2020; DOI: 10.3171/2020.1.SPINE191455.Disclosures Dr. Jiang is a consultant for Longeviti Neuro Solutions, and receives grant funding from DePuy Synthes. Dr. Gailloud is a consultant for Cerenovus, and he receives an unrelated research grant from Siemens Medical. Dr. Wolinsky is a consultant for AO Foundation, Siemens, and Icotec. Dr. Theodore receives royalties and has an ownership interest in Globus Medical, and he is a consultant for Globus Medical and DePuy-Synthes.
TanakaHMinatoyaKMatsudaHEmbolism is emerging as a major cause of spinal cord injury after descending and thoracoabdominal aortic repair with a contemporary approach: magnetic resonance findings of spinal cord injury. Interact Cardiovasc Thorac Surg. 2014;19(2):205–210.
TanakaH, MinatoyaK, MatsudaH, Embolism is emerging as a major cause of spinal cord injury after descending and thoracoabdominal aortic repair with a contemporary approach: magnetic resonance findings of spinal cord injury. . 2014;19(2):205–210.)| false
ReynoldsJMBelvadiYSKaneAGPoulopoulosM. Thoracic disc herniation leads to anterior spinal artery syndrome demonstrated by diffusion-weighted magnetic resonance imaging (DWI): a case report and literature review. Spine J. 2014;14(6):e17–e22.
ReynoldsJM, BelvadiYS, KaneAG, PoulopoulosM. Thoracic disc herniation leads to anterior spinal artery syndrome demonstrated by diffusion-weighted magnetic resonance imaging (DWI): a case report and literature review. . 2014;14(6):e17–e22.)| false