Anterior disco-osteo-arterial conflict as a cause of intersegmental arterial flow impairment and spinal cord ischemia

Introduction: This article describes anterior disco-osteo-arterial conflict as an insofar unsuspected mechanism of arterial flow impairment potentially leading to spinal cord ischemia and infarction. Methods: The anterior disco-osteo-arterial conflict described in this report is illustrated with angiographic observations of patients presenting with spinal cord ischemia documented by MRI, and radiculomedullary flow impairment diagnosed by spinal digital subtraction angiography and spinal CTA. Results: Proximal intersegmental artery flow impairment was found in association with anterior disc bulging and anterior osteophytic formation, alone or in combination. Patients either presented with an initial acute medullary syndrome or with a long-standing history of spinal claudication with acute secondary pejoration. Conclusion: Spinal ischemia can be the result of intersegmental and radiculomedullary flow impairment caused by an anterior disco-osteo-arterial conflict.