Aetiologies, pathogenesis and clinical outcomes associated with spinal cord infarction: Systematic review

Spinal cord infarction (SCI) is a rare condition caused by ischemic injury leading to spinal cord cell death. Its diverse aetiologies, combined with the spinal cord's intricate vascular anatomy, present diagnostic and surgical challenges. Despite its rarity, comprehensive research is warranted to inform future diagnostic and management protocols.

A systematic review adhering to PRISMA 2020 guidelines was conducted to analyse SCIs over a 25-year period (1998-2023). Data from PubMed, Ovid MEDLINE and Google Scholar were included from case reports, case studies and literature reviews, with the paediatric population being excluded.

Of 200 articles, 21 studies were analysed, evaluating 734 patients. SCI showed a male predominance (60.1 %) and a mortality rate of 8.4 %. The most frequent complication was urinary or faecal incontinence (36.3 %). Key aetiologies included cardiovascular (13.6 %), peri-/post-procedural (12.4 %), and cryptogenic causes (5.8 %). 43.9 % of cases were treated medically, while 6.1 % were managed with lumbar drains. ASIA scores at onset revealed: A (30.6 %), B (23.8 %), C (21.4 %) and D (25.2 %).

SCI poses significant morbidity and mortality. Of note, aortic diseases and cardiovascular factors are critical contributors. MRI, particularly DWI, remains crucial for diagnosis. However, treatment lacks standardisation due to limited data and delayed diagnoses. Current therapies range from antiplatelets to innovative surgical approaches, but further research is essential to develop evidence-based practices and refined protocols for enhancing patient outcomes.