The positive effect of combined treatment with thrombolysis and neurosurgery for cervical myelopathy due to anterior spinal artery thrombosis

Purpose: Vascular-related spinal cord injury accounts for 5.8% cases of acute myelopathy, whereas spinal cord ischemia is identified 100 times less often than a cerebral stroke. Ischemic myelopathy can also occur due to mechanical compression exerted by an osteophyte on the anterior spinal artery. So far there have been no clear guidelines for the management of such a patient. It seems that a recombinant tissue plasminogen activator (rtPA) could be used in the treatment. The available literature reports one paraplegic patient with thoracic spinal cord ischemia, who had been treated with rt-PA with a moderately favourable outcome.

Case description: We present a case of a patient with cervical spinal cord ischemia, whose paresis resolved almost completely after having received combined treatment with thrombolysis and neurosurgery.

Comment: We would like to emphasise that in spinal cord ischemia, and also if it is caused by mechanical compression of osteophyte on the artery, intravenous thrombolysis before surgery can prevent complete spinal cord infarction. The possibility to administer rt-PA in treating spinal cord ischemia should be included in the guidelines for the management of ischemic stroke. Close cooperation between neurologist and neurosurgeon is necessary to provide combined treatment promptly.