Abstract Details

Title Spinal Claudication Due to Anterior Disco-osteo-arterial Conflict Mimicking Stiff Person Syndrome

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-024

Objective To describe a case of vascular claudication of the spinal cord caused by anterior disco-osteo-arterial conflict.

Background Anterior intervertebral disc herniation may cause intersegmental artery compression due to disco-osteo-arterial conflict, a recently recognized rare cause of spinal cord ischemia.

Design/Methods N/A

Results A 68-year-old man presented with a 2-year history of severe muscle spasms in the lower back and pelvic region. His symptoms were always precipitated by a predictable period of walking or sustained erect posture. The patient was ultimately referred to our clinic for evaluation of “treatment-resistant” stiff person syndrome. Neurological examination was remarkable only for depressed reflexes in the lower extremities. Nerve conduction studies, electromyography and extensive laboratory testing for autoimmune/rheumatological conditions were unremarkable. MRI lumbar spine showed mild lumbar spondylosis with notable anterior disc degeneration from L1 to L3 (images will be presented). Spinal digital subtraction angiography revealed a proximal non-ostial stenosis of the left L2 intersegmental artery from which the main anterior radiculomedullary artery (artery of Adamkiewicz) arose. Fluoroscopic CT angiogram visualized the bilateral intersegmental arteries at L2-L3 coursing superiorly over an anterior disc osteophyte complex. Correlation of the clinical picture and imaging findings led to the inference that the patient’s symptoms were related to vascular claudication from degenerative changes at L2-L3 compressing the left L2 intersegmental artery. He underwent an L2-L3 transforaminal lumbar interbody fusion and immediate post-operative angiogram showed robust flow through both L2 intersegmental arteries with no evidence of the previously noted segmental narrowing. Six months post-surgery he reported marked improvement in his symptoms and increased exercise tolerance.

Conclusions Exercise-induced neurological symptoms in the lower extremities should prompt consideration of dynamic structural or vascular pathology of the spinal cord. This unusual case demonstrates how the intersegmental arteries can be vulnerable to compression from degenerative pathology as they course anteriorly across the intervertebral space.

Authors/Disclosures
Olwen Murphy, MD (Johns Hopkins Hospital) PRESENTER	Dr. Murphy has nothing to disclose.
Philippe Gailloud, MD (The Johns Hopkins Hospital)	Dr. Gailloud has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Cerenovus. Dr. Gailloud has received stock or an ownership interest from ArtVentive. The institution of Dr. Gailloud has received research support from Siemens Medical.
Scott D. Newsome, DO, FAAN (Johns Hopkins Hospital)	Dr. Newsome has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Newsome has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Newsome has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. The institution of Dr. Newsome has received research support from Biogen. The institution of Dr. Newsome has received research support from Genentech/Roche. The institution of Dr. Newsome has received research support from Department of Defense. The institution of Dr. Newsome has received research support from Patient Centered Outcomes Research Institute. The institution of Dr. Newsome has received research support from National MS Society. The institution of Dr. Newsome has received research support from Lundbeck. The institution of Dr. Newsome has received research support from Sanofi. The institution of Dr. Newsome has received research support from Kyverna Therapeutics. Dr. Newsome has received personal compensation in the range of $10,000-$49,999 for serving as a Lead PI for Clinical Trial with Roche.

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