1243 - Rehabilitative Management of the Anterior Spinal Artery Syndrome Patient

Objectives: Anterior Spinal Artery Syndrome (ASAS) is a rare pathology affecting the anterior 2/3 of the spinal column. Most commonly, ASAS develops iatrogenically following aortic surgery. Due to the high degree of permanent disability and dysfunction, optimized medical treatment is vital for disease management. The purpose of this review is to compile the symptomatic presentations of anterior spinal artery syndrome and act as a reference for the most up to date management methods for rehabilitation of an ASAS patient.

Design: Literature review

Results: One of the most important means of ASAS management is immediate reversal of the offending etiology once identified. A patient-centric interdisciplinary approach should be employed in physical rehabilitation of this pathology’s sequelae. Recent studies have shown that in addition to medical management, physical therapy is crucial for flaccid paraplegia. Additionally, nerve transfer surgery may prove beneficial in denervated musculature, however this is a newer modality presenting with mixed results. Management of pain and spasticity should include NSAIDs, tricyclic antidepressants, muscle-relaxants, baclofen, and botulinum toxin. Botulinum toxin may also be employed in cases of neurogenic bladder. Spinal cord stimulation has shown some promise in management of pain and spasticity, however, still needs to be studied on a larger scale in this unique etiology. To ensure whole-person treatment, providers should also endeavor to address less commonly discussed sequelae such as sexual function and psychological distress.

Conclusions: ASAS is a challenging condition to manage long term, but an interdisciplinary team that takes a patient-centered approach to managing the diverse symptomatic manifestations discussed in this review can foster improved quality of life for patients.