Clinical Features and Outcomes of Posterior Spinal Artery Infarctions - A Review

Posterior spinal artery infarctions are rarely described in the literature. Their clinical features and outcomes are poorly understood, and guidance on their treatment is lacking.

To describe the features of posterior spinal artery infarctions and to identify factors associated with poorer ambulatory outcomes.

We conducted a literature review on the characteristics and outcomes of patients with posterior spinal artery infarctions reported over the past 30 years.

We analyzed 40 cases from 33 studies published from January 1993 to June 2023. Their median age was 55 years (range 19-84), with 23 males and 17 females. Pain (18/39, 46%) was common, and hemiparesis and/or hemisensory deficits occurred in a significant number of cases (16/39, 41%). Infarcts preferentially affected the cervical cord (29/40, 73%). Most received treatment (28/40, 70%), which usually involved the use of antiplatelet agents (18/28, 64%), anticoagulants (8/28, 29%), (18/28, 64%), and/or corticosteroids (5/28, 18%). The prognosis appeared fair as most could ambulate (28/34, 82%), but nearly a third of them required assistance (8/28, 29%). Older patients, (median [range]: 67 years [52-84] vs 56 [28-79], P = 0.055), experienced trauma (50% vs 11%, P = 0.053), or with infarcts involving three or more cord segments (83 vs 33%, P = 0.062) may increase the risk of non-ambulant outcomes.

PSAIs are uncommon and may mimic cerebral strokes. Diagnostic clues include preceding trauma, endovascular treatment, and concomitant pain. Its prognosis appears favourable with most patients being able to ambulate. Advanced age, prior trauma, and longer infarcts may herald poorer ambulatory outcomes.