Vertebral Bone Infarction: A Key Clue in Identifying Spinal Cord Strokes

BackgroundSpinal cord stroke (SCS) is rare and frequently misdiagnosed. This study describes the clinical and radiological characteristics of vertebral body infarction (VBI) associated with SCS. MethodsTo assess VBI in patients with SCS, we retrospectively examined clinical data and magnetic resonance imaging from patients diagnosed at a specialized referral center. VBI was defined as a T2-weighted hyperintensity within a vertebral body near ischemic cord lesions. Additional features, such as gadolinium enhancement, lesion distribution, and the exclusion of other explanations, were also analyzed. Each vertebra was evaluated for its level, pattern of signal changes, and enhancement, then correlated with the lesion distribution and related arterial spinal supply. ResultsAmong 126 patients with SCS, 15 (12%) showed MRI evidence of VBI. Thirteen patients (87%) had multiple vertebrae affected, with 80% of cases involving two adjacent vertebral bodies. Of the 35 vertebrae displaying signs of VBI, 20 (57%) were thoracic, 9 (25%) were cervical, and 6 (17%) were lumbar. In 80% of SCS cases, VBI MRI abnormalities were found at the same or lower vertebral levels corresponding to the cord lesions; these were typically hyperintense on T2-weighted and STIR sequences, with 92% showing contrast enhancement. The location of the ischemic lesions in the vertebral bodies was anterolateral (47%), posteramedial (23%), hemivertebral (17%), or posterolateral (9%), with two vertebrae showing diffuse involvement. The spinal vascular territories included the artery of Adamkiewicz (n=9, 60%), the upper artery of the cervical enlargement (n=6, 40%), the artery of von Haller (n=5, 33%), and the lower artery of the cervical enlargement in two cases (13%). ConclusionThe co-occurrence of VBI and SCS is attributable to their shared arterial supply, as the MRI findings in VBI generally mirror the spinal vascular anatomy. VBI serves as a key indicator of vascular injury and an important diagnostic marker for SCS.