- 1.1Etiology and pathogenesis of myelopathy
- 1.2Symptoms of myelopathy
- 1.3Ischemic myelopathy
- 1.4Post-traumatic myelopathy
- 1.5Radiation Myelopathy
- 1.6Carcinomatous myelopathy
- 1.7Treatment of myelopathy
- 1.8Prognosis and prevention of myelopathy
2All about myelopathy
- 2.2The main reasons can be divided into several groups:
- 2.6As an instrumental survey used:
3Myelopathy: symptoms and treatment
4Myelopathy of the spinal cord, types and methods of treatment
- 4.1Types of spinal cord lesions
- 4.3General symptoms
- 4.4Compression and brain damage
- 4.5The cause in vascular pathology
- 4.6Rare varieties of brain damage
- 4.7Methods of examining patients
- 4.8How to cure patients
Myelopathy- a generalized concept used in neurology to denote different in their etiology of spinal cord lesions, usually having a chronic course.
Clinically, they can manifest violations of strength and muscle tone, various sensory disorders, dysfunction of the pelvic organs. The task of diagnostic search in myelopathy is to identify the causative disease.
To this end, X-rays of the spine, MRI, EMG, ENG, angiography, analysis of cerebrospinal fluid, biochemical blood tests, PCR diagnostics, etc. are performed.
Therapeutic tactics is based on the therapy of the underlying disease, symptomatic treatment and rehabilitation with the help of exercise therapy, mechanotherapy, massage, acupuncture and physiotherapy.
Myelopathy is a complex concept that includes any dystrophic changes in the spinal cord, regardless of their etiology.
As a rule, these are chronic or subacute degenerative processes that occur as a result of impaired blood supply and metabolism of individual spinal segments.
Often, myelopathy acts as a complication of degenerative-dystrophic diseases of the spine, vascular pathology, toxic effects, spine trauma, dysmetabolic changes or infectious processes.
Therefore, in the refined diagnosis, the term "myelopathy" must necessarily indicate the nature of the lesion of the spinal cord. For example, "ischemic myelopathy "compression myelopathy and so on.
Etiology and pathogenesis of myelopathy
In the predominant majority of cases, pathological processes leading to the development of myelopathy are localized outside the spinal cord.
First of all, these are degenerative changes of the spine (osteochondrosis, spondylarthrosis, spondylosis, involuntary spondylolisthesis) and trauma (vertebral fracture, subluxation or vertebral dislocation, compression fracture spine).
They are followed by vascular diseases (atherosclerosis, spinal vascular thrombosis), spine development anomalies, tumor processes in the area spine, metabolic disorders (with disproteinemia, diabetes, phenylketonuria, lysosomal accumulation diseases), tuberculosis and osteomyelitis the spine. Pathological changes in the spinal cord can lead to radioactive and toxic effects on the body..
Less common are myelopathies, caused by direct damage to the substance of the spinal cord..
The root cause of their occurrence can be: vertebral-spinal trauma, infectious lesions and tumors of the spinal cord, hematomyelia, demyelination. The latter can be hereditary (with the syndrome of Russi-Levi, the illness of Refsum,
) or acquired (with multiple sclerosis) character. In exceptional cases, myelopathy develops as a complication of lumbar puncture.
Among the pathogenetic mechanisms of myelopathy, compression predominates. It is possible to compress the intervertebral hernia, osteophytes, fragments in fracture, tumor, posttraumatic hematoma, displaced vertebra.
In this case, both direct compression of the spinal cord and compression of the spinal vessels take place, the consequence which is hypoxia and malnutrition, and then the degeneration and death of nerve cells of the affected spinal cord segment. The emergence and development of pathological changes is realized gradually with increasing compression. The result is the loss of the function of the neurons of this segment and the blocking of the impulses passing through it, proceeding along the conducting paths of the spinal cord.
In modern neurology, myelopathy is traditionally classified according to the etiological principle.
- Spondylogenic(incl. discogenic) - is associated with various degenerative processes of the spinal column.
- Ischemic(dyscirculatory, atherosclerotic, vascular) - develops against a background of chronic impairment of cerebrospinal circulation.
- Post-traumatic- is caused both by direct trauma of the spinal cord (concussion, bruise), and with the compression effect of the hematoma, displaced vertebrae or their parts in fracture.
- Carcinomatous- is a manifestation of paraneoplastic lesion of the central nervous system in leukemia, lymphoma, lymphogranulomatosis, lung cancer, etc. oncological pathology.
- Infectious- occurs in HIV, syphilis (neurosyphilis), Lyme disease, enterovirus infection in children.
- Toxic- due to toxic effects on the central nervous system. It can be observed with diphtheria.
- Radiation- depends on the dose and time of radioactive irradiation. Radiation myelopathy can occur after radiation therapy of malignant neoplasms.
- Metabolic- a rare complication of endocrine and metabolic disorders.
- Demyelinating- the result of hereditary or acquired demyelinating processes in the central nervous system.
Symptoms of myelopathy
Clinically, myelopathy is manifested by a number of neurological symptoms that are have specific features reflecting its etiology, and entirely depend on the level and degree of damage to the spinal cord the brain.
In general, the myelopathic symptom complex includes peripheral paresis / paralysis with muscular hypotension and hyporeflexia, developing on level of affected segments; central paresis / paralysis with muscle hypertension and hyperreflexia, extending below the level of localization pathological changes; hypesthesia and paresthesia both at the lesion level and below it; Pelvic disorders (retention or incontinence of urine and feces).
Discogenic myelopathy, infectious myelopathy, and compression myelopathy are discussed in relevant independent reviews.
Spinal vessels are much less likely to form atherosclerotic plaques and thrombosis than cerebral vessels (cerebral vessels). As a rule, this occurs in people over 60 years of age.
The most sensitive to ischemia are the motoneurons located in the anterior horns of the spinal cord. For this reason, in the clinical picture of vascular myelopathy, motor disorders play a leading role, which resembles the manifestations of ALS.
The disorders of the sensitive sphere are minimal and can only be detected with a thorough neurological examination.
It is a spinal syndrome that develops depending on the severity of the trauma and course of the nearest post-traumatic period.
On clinical manifestations often has much in common with syringomyelia, in particular a dissociated type of sensitive disorders: loss of surface (temperature, pain and tactile) sensitivity with the preservation of deep (musculo-articular and vibrational). Usually posttraumatic myelopathy is irreversible and forms the basis of residual (residual) trauma phenomena. In some cases, its progressive progress is noted with the progression of sensory disturbances. Often post-traumatic myelopathy is complicated by intercurrent urinary tract infections (cystitis, urethritis, pyelonephritis); sepsis is possible.
It is most often observed in cervical spinal segments in patients who underwent radiation therapy for cancer Throat or laryngeal cancer; in the thoracic region - in patients receiving radiation for tumors the mediastinum. It develops in the period from 6 months to 3 years after the radiation load; on average after 1 year. In such cases myelopathy needs differential diagnostics with spinal metastases of an existing tumor. Typically, the slow progression of the clinic, due to the gradual necrosis of the tissues of the spinal cord. With a neurologic examination, Brown-Sekar syndrome can be detected. In the cerebrospinal fluid, no changes are observed.
It is caused by the toxic effect of the tumor and the effect of the biologically active substances synthesized by it, which ultimately leads to necrotic changes in the spinal structures.
The clinical symptom complex in many respects repeats neurologic disorders with amyotrophic lateral sclerosis. Therefore, some authors attribute this kind of myelopathy to a special form of ALS.
In the cerebrospinal fluid, pleocytosis and mild hyperalbuminosis can be detected.
The diagnostic algorithm for detecting signs of myelopathy is aimed at excluding another, similar in clinical symptoms, pathology of the central nervous system and the establishment of the etiological factor underlying the dystrophic changes in the spinal the brain.
It includes a general and biochemical blood test, spine X-ray, MRI of the spine, electromyography (EMG), electroneurography (ENG), study of evoked potentials, MR or CT angiography of the spinal cord, lumbar puncture.
According to the indications, in the absence of the possibility of conducting an MRI, in some cases, myelography and discography can be performed. When suspected of the infectious nature of myelopathy, a blood test for sterility, an RPR test, a PCR test, and a cerebrospinal fluid culture are performed.
During the diagnostic search, the neurologist may involve other specialists in joint counseling: vertebrologist, phthisiatrist, oncologist, venereologist; with the assumption of demyelinating hereditary myelopathy - genetics.
Treatment of myelopathy
The tactics of treating myelopathy depend on its etiology and clinical form. It includes the therapy of a causative disease and symptomatic treatment.
With compression myelopathy, elimination of compression is paramount. For this purpose, removal of the Urbana wedge, drainage of the cyst, removal of the hematoma and tumor can be indicated.
With the narrowing of the spinal canal, the patient goes to the neurosurgeon to decide whether a decompressive surgery is possible: laminectomy, facetectomy, or puncture decompression of the disc..
If compression myelopathy is caused by herniated intervertebral disc, then depending on the degree of protrusion and the condition of the disk, microdiscectomy or discectomy is performed..
Treatment of ischemic myelopathy is to eliminate factors of vascular compression and vascular therapy.
Since the vascular component is present in the pathogenesis of virtually any myelopathy, similar treatment is included in the complex therapy of most patients.
It includes antispasmodic and vasodilating agents (drotaverine, xanthinal nicotinate, papaverine, vinpocetine), drugs that improve microcirculation and rheological properties of blood (pentoxyphylline).
With toxic myelopathy, the basis of treatment is detoxification, with infectious - an adequate etiology of antibiotic therapy.
Great difficulties are the treatment of hereditary demyelinating myelopathy and carcinomatous myelopathy in hemoblastoses.
Often it boils down to symptomatic therapy.
Obligatory in the treatment of myelopathy are drugs that improve the metabolism of nervous tissue and reduce its susceptibility to hypoxia..
These include neuroprotectants, metabolites and vitamins (pig brain hydrolyzate, piracetam, blood calves calves, vit B1, vit B6)..
Many patients are shown the consultation of a physiotherapist for the optimal selection of methods for physiotherapy: diathermy, galvanization, UHF, paraffin therapy, etc.
In order to increase the volume of motor activity, develop self-service skills, prevent the development of complications (muscle atrophy, contracture of joints, pressure sores, congestive pneumonia) from early terms of myelopathy patients is shown exercise therapy, massage and rehabilitation physiotherapy (electrostimulation, neostigmine electrophoresis, reflexotherapy, CMT of paretic muscles, hydrotherapy). With deep paresis, exercise therapy consists of performing passive exercises and mechanotherapy.
Prognosis and prevention of myelopathy
In the case of timely elimination of compression compression myelopathy has a favorable course: with appropriate treatment, its symptoms can be largely reduced.
Ischemic myelopathy often has a progressive course; repeated courses of vascular therapy can temporarily stabilize the condition. Post-traumatic myelopathy, as a rule, is stable: its symptoms are not reduced and do not progress.
An unfavorable prognosis and steadily progressing course are radiation, demyelinating and carcinomatous myelopathy.
Preventing myelopathy is to prevent diseases that can lead to its development.
This timely detection and treatment of the pathology of the spine and vascular diseases; stable compensation of endocrine and metabolic disorders; prevention of injuries, infectious diseases, intoxications with lead, cyanides, hexachlorophene and etc.
A source: http://www.krasotaimedicina.ru/diseases/zabolevanija_neurology/myelopathy
All about myelopathy
The spinal cord is the fundamental "axis" of our nervous system, through which the brain connects with the rest of the body.
That is why myelopathy can lead to the most serious consequences up to total loss of ability to work.
And clearly delineate the "risk group" is impossible, because due to the variety of reasons for its occurrence, the child, active sports youth, and middle-aged and older people can get sick.Here are some age categories of patients:
- children who survived enterovirus infection;
- young people (from 15 to 35 years) who received a spinal cord injury;
- people of middle age (30-50 years) with primary tumor;
- elderly (from 55 years) people with degenerative changes of the spine because of old recurring injuries; most often those are those whose occupations are associated with physical stress.
Depending on the diseases that have become the root cause of myelopathy, we can identify some more groups, for example, cancer patients or people with changes in bone tissue due to arthrosis and osteoporosis.
The main reasons can be divided into several groups:
- physical impact on the spinal cord as a result of traumatic or degenerative deformations of the spine;
- violation of cerebrospinal circulation;
- viral infection;
- tumors of various genesis;
- poisoning with toxic substances;
- radioactive irradiation;
- disorders of metabolism and endocrine system;
- demyelination (destruction of the myelin sheath of the nerve) of the central nervous system.
Such a wide range of possible factors that cause myelopathy also affects the multivalued classification of the disease.
In the place of spinal cord injury, the disease is divided into myelopathy of the cervical, thoracic and lumbosacral spine.
On the etiology (cause of occurrence) of myelopathy allocate a much larger number of options. And in this case the disease gets a double name, where the first is the explanatory term.The main types of disease include:
- vertebrogenic(spondylogenous, discogenic, cervical myelopathy) - is caused by compression (compression) of the spinal cord under the mechanical action of deformations spine, caused by osteochondrosis, spondyloarthrosis, herniated discs and other diseases, accompanied by a violation of the form vertebrae;
- atherosclerotic(dyscirculatory, ischemic) - manifests itself in the violation of blood circulation and various pathologies of blood vessels;
- carcinomatous- is a manifestation of the CNS lesion in oncological diseases;
- posttraumatic- to it carry as a trauma of the spinal cord (for example, a bruise, a concussion, damage at spinal puncture), and the compression effect on it as a result of integrity violations vertebral column;
- metabolic- occurs as a complication in metabolic and endocrine disorders of the body;
- post-beam(radiation) - is caused by radiation exposure and is most often a consequence of radiation therapy;
- infectious- can occur with various infectious diseases (for example, with HIV, neurosyphilis or enterovirus infection);
- toxic(intoxication) - occurs with a poisoning effect on the central nervous system (CNS), for example, in diphtheria;
- demyelinating- is due to hereditary factors or multiple sclerosis.
There are really a lot of options for spinal cord injury, therefore, in any of the listed cases of injuries or illnesses, it is worthwhile to check for possible myelopathy.
It is not so simple to determine this illness independently.
In the early stages, especially in cases of primary myelopathy accompanied by severe pain, spinal cord injury is almost impossible to detect.
A pronounced symptom complex is characteristic of higher levels of myelopathy.And the most common signs of it, regardless of etiology, are:
- back pain, often irradiating (giving off) in the limb, the rib or waist region, which can be perceived as heart or kidney pain;
- muscle weakness of varying degrees;
- a decrease in the sensitivity of the skin (any - tactile, painful, temperature, musculo-articular feeling or all at once) to complete numbness;
- violation of the motor skills of voluntary movements - convulsions, paresis or partial paralysis;
- manifestations of dysfunction of the pelvic organs - the bladder and intestine.
If such symptoms occur, you need to urgently go to the neurologist, because the sooner myelopathy is diagnosed, the better the chances of recovery.
As with any disease with a complex genesis (origin), the doctor, first of all, should exclude the possibility of other ailments of similar symptoms. Therefore, in addition to visual examination with palpation, laboratory and hardware studies are always used.
The laboratory methods include not only the analysis of blood (general, deployed and determining the level of inflammatory proteins), but also the study of cerebrospinal fluid, bone and (or) soft tissue.
As an instrumental survey used:
- X-ray (computerized X-ray tomography) - for visualization of the condition of the spine bones;
- magnetic resonance imaging - for visual examination of the spinal cord (its compression, deformation), the presence of tumors;
- electromyography, electroneurography - to assess the level of lesion of the central nervous system and peripheral nerves.
Such a diagnostic algorithm makes it possible to determine the state of the spinal cord most accurately.
The effectiveness of the treatment of myelopathy of the spinal cord depends on the degree of brain damage, and on its etiology. That is why, in addition to symptomatic treatment, primary therapy is mandatory.
For each type of myelopathy, a course of treatment is shown, which can be both therapeutic (with intoxication, infectious, carcinomatous and other forms), and operable (for example, compression form). In any case, treatment should eliminate (or at least mitigate) the effect of the underlying disease on the spinal cord, for which in conjunction with the neuropathologist are the doctors of other necessary specializations.
But there is also compulsory treatment, prescribed to most patients with myelopathy. It includes:
- vascular therapy, which includes the use of spasmolytic and vasodilating drugs, as well as agents that improve rheological properties and microcirculation of blood;
- neuroprotective therapy, restoring the metabolism of the nervous system and reducing its susceptibility to hypoxia;
- physiotherapy, massage and exercise therapy, recommended for chronic (neostrom) myelopathy.
And yet, despite the well-established practice of treatment, it is by no means possible in all cases to completely get rid of the disease.
The situation with myelopathy is complicated by the fact that with some primary diseases that can not be completely cured, their negative impact on the spinal cord can not be stopped. The worsening of the CNS condition (the growth of damage to nerve tissues)leads to paraplegia, quadriplegia or complete paralysis.
There are no special prevention methods for myelopathy.Basically, the usual measures to maintain the spine in a healthy state are recommended:
- Execution of exercises aimed at the formation of a supporting muscular corset;
- maintaining a fairly active lifestyle, including the feasible burden on the spine;
- the correct choice of a sleeping place (for example, selection of an orthopedic mattress or the equipment of a semi-rigid bed);
- refusal from smoking and fatty foods, contributing to a decrease in the elasticity of blood vessels.
To this is added the prevention of the prevention of diseases that are the cause of myelopathy, which include pathologies of the spine, vascular disease, endocrine and metabolic disorders, infectious diseases, lead poisoning, cyanide and other toxic substances, as well as a warning injuries.
Complete recovery in case of disease depends not only (and even not so much) on the timeliness of its detection, how many of the factors that cause it. So, compression myelopathy, like post-traumatic, is completely curable with complete elimination of the causes of the onset.
The most unfavorable prognosis for recovery is carcinomatous, post-radial and demyenylizing myelopathy, in whichIt is almost impossible to stop the process of further destruction of nerve tissues.
The remaining types of myelopathy can hardly be predicted. For many of them, complete cure is unattainable due to incurable disease-causes, at best it is possible to achieve a stable state without deterioration.
These include, for example, the ischemic or metabolic forms of myelopathy.
In toxic and infectious forms of myelopathy, recovery depends on the degree of damage to the spinal cord and fluctuates from stable remission at the initial levels to complete immobility in the fatal destruction of the nervous tissue.
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A source: http://pillsman.org/21902-mielopatiya.html
Myelopathy: symptoms and treatment
Category: Neurology and psychiatry 7803
Myelopathy is a term that characterizes a group of non-inflammatory diseases, for which a dystrophic spinal cord injury is characteristic. More often clinicians diagnose cervical myelopathy, which begins to progress against a background of spondylosis or osteochondrosis, as well as myelopathy of the thoracic spine.
The main etiological factors of myelopathy of the spine:
- fracture of the vertebra in a certain section of the spine;
- vertebral dislocation;
- defects in the development of the spine;
- toxic and radiation damage to the human body;
- osteomyelitis of the spine;
- a metabolic disorder;
- tumors of benign or malignant nature, located in close proximity to the spine;
- vertebral-spinal cord injury;
- a tumor of the spinal cord.
- cervical myelopathy.It is also called the cervix. This form of pathology begins to progress due to congenital stenosis of the spinal canal, trauma various degrees of severity, craniovertebral anomalies, compression of the spinal cord with tumor education. In addition, cervical myelopathy proceeds against cirrhosis, Lyme disease, insufficient intake of vitamins B and E;
- atherosclerotic form.Begins to progress after the accumulation of cholesterol plaques on the walls of blood vessels that supply blood to the spinal cord. The following pathologies contribute to this: heart disease, systemic atherosclerosis, hereditary metabolic disorder;
- vertebrogenic myelopathy.Progresses against a background of an osteochondrosis of a backbone, intervertebral hernias. Occurs in 2 clinical forms - acute and chronic. An acute form is caused by a trauma. More often it is diagnosed in car accidents. While the car with the driver is colliding with another car, there is a specific "whiplash". The neck and head are sharply shifted forward, and then back. As a result, the vertebrae or intervertebral discs are displaced in the cervical spine.
Chronic form of pathology develops in the presence of a long-term progressive osteochondrosis (when osteophytes actively grow). These specific formations compress the spinal cord in any part of the spine (usually in the cervical and thoracic):
- radiation form.Progresses after the radiotherapy (in the presence of malignant tumors);
- toxic form.Develops after long exposure to toxic active substances on the central nervous system;
- infectious form.Often diagnosed against HIV, Lyme disease and others;
- carcinomatous form.Develops with leukemia, lymphoma, lymphogranulomatosis, oncological pathologies;
- demyelinating form.
Symptoms of myelopathy directly depend on the cause of the disease, as well as on the form of the process. The first symptom of pathology is the pain syndrome in the affected spine. After the clinical picture is supplemented by the following symptoms:
- The strength of muscles in the zone of localization of the lesion is reduced, up to the development of paralysis;
- decrease in skin sensitivity in the affected area;
- it is difficult for a person to perform arbitrary movements for him;
- if the spinal cord was injured in the lumbar region, then the functioning of the internal organs may malfunction - involuntary discharge of feces or urine, constipation.
MRI with myelopathy
Symptoms of cervical damage:
- loss of sensitivity of the skin of the hands and neck;
- spasms or twitching of the muscles of the hands;
- severe pain in the neck, scapular region.
Symptoms of myelopathy of the thoracic spine:
- weakness of the hands;
- pain in the heart, similar in intensity to pain in the infarction;
- decreased sensitivity;
- pain syndrome in the region of the ribs. This symptom tends to increase during the person's making inclines in different directions;
- the person notes that he has a feeling of tingling or twitching in the muscles of the back, sternum.
Diagnosis of myelopathy is performed by a neurologist. After visual inspection, the specialist can additionally assign instrumental and laboratory examination methods.
- X-ray examination;
- taking a cerebrospinal fluid for subsequent sowing.
The choice of methods for treating myelopathy depends on the cause of its progression and on the form. The main goal - to cure the root cause of the disease, as well as to eliminate unpleasant symptoms.
Treatment of compression myelopathy is carried out only after the compression of the vertebrae has been eliminated. Held:
- drainage of cystic formations;
- removal of the formed hematoma;
- removal of the wedge Urbana.
Treatment of narrowing of the spinal canal:
If ischemic myelopathy was diagnosed, then specialists first eliminate the cause of vascular compression. The treatment plan includes vasodilator and antispasmodics:
- papaverine (helps to calm the spasm and reduce the appearance of unpleasant symptoms);
Medication and physiotherapy treatment:
- vitamin therapy;
- paraffin therapy;
- diathermy and other.
To normalize the motor activity, as well as to stop the progression of various dangerous complications, appoint:
- Exercise therapy;
- electrophoresis with proserin;
- CMT of paretic muscles;
Diseases with similar symptoms:
Radicular syndrome (coinciding symptoms: 3 of 18)
Radicular syndrome is a complex of symptoms that arise during the process of squeezing spinal roots (that is, nerves) in those places where their branch from of the spinal cord.
Radicular syndrome, the symptoms of which are somewhat contradictory in its definition, is in itself a sign many different diseases, in view of which the importance of timely diagnosis and the designation of an appropriate treatment.
... Intervertebral hernia (coinciding symptoms: 3 of 18)
Intervertebral hernia is a characteristic protrusion or prolapse, which is carried out in the vertebral canal by fragments of the intervertebral disc.
The intervertebral hernia, the symptoms of which are manifested due to getting injuries to the patients or in the presence of osteochondrosis, is manifested among other things in the form of compression of the nervous structures.
... Kifoscoliosis (coinciding symptoms: 3 of 18).
Kifoskolioz - an ailment that affects the thoracic spine. Pathology simultaneously combines the symptoms of kyphosis and scoliosis..
When the scoliosis progresses in a person, a curvature of the spine to the left or to the right is observed. With kyphosis, the bend increases posteriorly. For kyphoscoliosis, both are characteristic.
More often it is diagnosed in adolescents in adolescence.
... Spasmophilia (coinciding symptoms: 3 of 18)
Spasmophilia is an ailment for which the appearance of seizures and spastic conditions, directly related to hypocalcemia in the blood, is characteristic. In medicine, pathology is also called tetany. Usually it is diagnosed in children aged 6 to 18 months.
Ankylosing spondylitis or Bechterew's disease is a systemic chronic inflammation that occurs in the joints and is concentrated, as a rule, in the spine.
Bechterew's disease, the symptoms of which are manifested in limiting the mobility of the affected area, is mainly relevant for men in the age category from 15 to 30 years, as for women, this disease they have in practice is 9 times less often.
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A source: http://SimptoMer.ru/bolezni/nevrologiya/1295-mielopatiya-simptomy
Myelopathy of the spinal cord, types and methods of treatment
Myelopathy refers to the pathology of the central nervous system and combines various diseases of the spinal cord. In the absence of proper treatment, the disease can lead to impaired pelvic organs, paralysis, paresis and other complications.
Types of spinal cord lesions
The central nervous system of man is represented by the spinal cord and the brain. The first is in the vertebral canal.
This organ is the link between the brain and tissues. It consists of several segments.
From the spinal cord the roots that regulate the work of the muscles and the sensitivity of the tissues depart.
Myelopathy is a group of diseases of various etiologies, at the basis of which degenerative (dystrophic) changes lie. In most cases, this is a complication of another pathology. Depending on the main etiological factor, the following types of myelopathy are distinguished:
The mechanism of their development is different. Myelopathy is most often diagnosed in adults.
Chronic pathology of the spinal cord is due to several factors. The following causes of myelopathy are known:
- pathology of the spine;
- congenital and acquired developmental anomalies;
- benign and malignant neoplasms;
- tuberculosis infection;
- exposure to toxic substances;
- spinal hemorrhage;
- violation of myelination;
- Refsum's disease;
- multiple sclerosis;
- abnormal lumbar puncture;
- intervertebral hernia;
- Lyme disease;
- enterovirus infection;
- HIV infection;
- lungs' cancer;
Myelopathy of the lumbar region is often diagnosed. It can be caused by the displacement of the vertebrae, osteochondrosis and spondyloarthrosis. Predisposing factors are:
- contact with sick people;
- acute and chronic infectious diseases;
- extreme sports;
- frequent bruises and falls;
- bites of ticks;
- burdened heredity;
- harmful occupational factors;
- violation of blood clotting.
Symptoms are determined by the lesion segment and the main cause. The most common signs are:
- restriction of movements in the limbs;
- increased muscle tone;
- amplification of reflexes;
- decrease or increase of sensitivity;
- retention of urine;
- fecal incontinence.
Vertebrogenic myelopathy is accompanied by signs of underlying pathology. Possible pain and decreased mobility of the spine.
The presence of symptoms of intoxication in the form of fever, headache and weakness indicates the infectious nature of myelopathy.
When the spinal cord is damaged, symptoms of impaired peripheral nerve function are possible.
Compression and brain damage
The most difficult is compression myelopathy. It is due to:
- squeezing the spinal cord with a tumor;
- bone fragments;
- hematoma or hernia.
For this pathology, sensitive and motor disorders are characteristic. The main causes are dislocations, fractures, subluxations, hemorrhages and displacement of the vertebrae.
The most acute is the acute compression form of myelopathy. With her symptoms appear abruptly, and the condition of patients rapidly deteriorates.
The main signs are flaccid paresis with a sensitivity violation in the area below the compression zone.
In severe cases, the function of the rectum and bladder worsens.
Spinal shock develops. Soon spastic paralysis is revealed. Appear pathological reflexes and appear seizures. Contractures are frequently developed (limitation of the volume of movements in the joints). When squeezing the spinal cord in the cervical segment, the following symptoms are observed:
- a feeling of numbness;
- dull pain in neck and shoulder girdle;
- muscle weakness in the upper limbs;
- decreased muscle tone;
- slight convulsions.
Sometimes the function of the facial nerve is disrupted. This occurs when the tissues are compressed in the region of segments 1 and 2. Such people are disturbed by the sensitivity of the face. To the more rare signs are the shakiness of the gait and the trembling in the hands.
Compression syndrome in the thoracic segment is characterized by an increase in the tone of the leg muscles and a violation of sensitivity in the trunk region. Compression in the lumbar region is manifested by pain in the buttocks and legs and a violation of sensitivity. With time, muscle atrophy develops.
If treatment is not performed, then a flaccid paresis of one or both legs develops.
The cause in vascular pathology
The cause of damage to the spinal cord can be a violation of blood circulation. This is vascular myelopathy.
This pathology occurs in acute or chronic form. At the base of the softening of the spinal cord is ischemia of the tissues.
The vascular form of myelopathy is a collective concept that unites the following pathology:
- spinal thrombophlebitis and phlebitis;
- subacute necrotic myelopathy;
- spinal cord infarction;
- thrombosis of the spinal arteries.
The cause may lie in the pathology of local or distant vessels. Ischemic myelopathy occurs mainly in people older than 60 years. The motor neurons of the anterior horns of the spinal cord are most often affected. The main reasons for the development of this pathology are:
- systemic vasculitis;
- syphilitic lesions of the arteries;
- nodular periarteritis;
- Vascular hypoplasia.
This spinal pathology most often occurs in people suffering from arterial hypotension and other cardiovascular pathologies.
Ischemic myelopathy can provoke medical manipulation and surgical interventions.
These can be epidural block, spinal anesthesia, plastic and clipping of the arteries..
Violation of blood circulation causes ischemia of the tissues of the spinal cord. The organ function is violated. If you do not treat a person, then necrosis occurs..
It is manifested by motor and sensitive disorders.
Acute ischemic myelopathy proceeds according to the type of stroke, intermittent claudication, Preobrazhensky's syndrome and lesion of the cerebrospinal arteries.
The following symptoms are possible:
- weakness in the legs;
- paresthesia during movements;
- decrease in temperature and pain sensitivity;
- violation of sensory perception;
- difficulty in movement.
With a unilateral lesion of the central spinal cord, Brown-Sekar syndrome develops.
It is manifested by increased muscle tone, reddening of the skin, ulcers, bedsores, violation of deep sensitivity, pain and difficulty of movement on the affected side. Developed sluggish and spastic paralysis.
Rare varieties of brain damage
Spine pathology develops spondylogenic myelopathy.
It is characterized by dystrophic changes in the spinal cord on the background of compression of the intervertebral hernia.
More often this pathology develops in people with a severe form of osteochondrosis. Mostly men are sick from 45 to 60 years.
Lesions of intervertebral discs cause the rupture of fibrous rings. Developed spondylolisthesis. Disks are displaced, and the intervertebral hernia is formed.
In the pathogenesis of the defeat of the spinal cord, there is a violation of blood circulation against the background of compression of the arteries and compression.
The peculiarity of vertebrogenic myelopathy is its gradual development.
The cervical segment of the spinal cord is most often affected.
Symptoms of vertebrogenic myelopathy include a central (spastic) paresis below the injury zone, peripheral (flaccid paresis) at the level of the hernia of the spine and a decrease in sensitivity. Movement disorders predominate over sensitive ones.
Initially, violations can be one-sided. Then all limbs are involved in the process. Often this form of myelopathy is combined with radiculitis. Often there is a syndrome of the vertebral artery.
It is manifested by dizziness, sleep disturbance, unsteadiness of gait, memory loss and noise in the head. When the spinal cord is damaged at the level of the waist, Achilles and knee reflexes decrease.
Sensitive ataxia develops..
Radiation myelopathy has been singled out separately. It most often develops in people who are irradiated for cancer of the mediastinum, throat and throat..
The first symptoms appear 1-3 years after exposure to ionizing radiation. This myelopathy progresses slowly. Necrosis of the spinal cord is possible against the background of tumors.
In this case we are talking about carcinomatous myelopathy.
Methods of examining patients
Diagnosis of this pathology based on complaints is difficult due to the non-specificity of the clinical picture. The doctor should exclude another pathology with similar symptoms. It is necessary to exclude discirculatory encephalopathy, neurosyphilis, syringomyelia, encephalitis, stroke and multiple sclerosis.
The following studies are required:
- CT or MRI of the spine;
- sowing of cerebrospinal fluid;
- lumbar puncture;
- general and biochemical blood tests;
- polymerase chain reaction;
- Wasserman's reaction;
- anticardiolipin test;
- blood test for sterility;
- Analysis of urine;
- exploring evoked potentials;
- genetic analyzes.
How to cure patients
Therapeutic tactics are determined by the cause of myelopathy. When vascular disorders require:
- use of vasoactive drugs;
- use of nootropics and neuroprotectors;
- elimination of compression.
To normalize the collateral circulation appoint papaverine, nicotinic acid and Eufillin. Vinpocetine is often included in the treatment regimen.
To improve microcirculation is shown Trental, Pentoxifylline-Eskom or Flexitale. Patients are often prescribed antiaggregants (Dipiridamol-Ferein).
Furosemide is used to eliminate spinal cord edema.
With hematomia, anticoagulants (Heparin) are necessarily used. To eliminate hypoxia, Mildronate or Meldonium is indicated.
The treatment regimen includes drugs that improve cognitive function. These include Noben and Galantamine. In addition, prescribe vitamins.
In the rehabilitation phase, massage and physiotherapy procedures are shown.
In the case of squeezing the arteries of the spinal cord, you may need to remove the hematoma, tumor, hernia or the removal of subluxation. In the treatment of posttraumatic myelopathy, such drugs as Ginkgo Biloba, Cavinton, Papaverin, Pentoxifylline-Eskom and pantothenic acid are used.
UHF-therapy, electrophoresis, mechanotherapy, massage, thermal procedures, electrostimulation and reflexotherapy are useful.
With the progression of myelopathy, surgery is required. In case of development of pelvic disorders, catheterization and washing of the bladder may be required..
The main method of treatment of infectious (bacterial) myelopathy is the use of systemic antibiotics. With toxic damage to the spinal cord, blood purification is necessary..
In motor disorders, therapeutic exercises, massage, hydrotherapy and physiotherapy are required.
This helps prevent contractures. LFK is of great importance.
With discogenic myelopathy, laminectomy, facetectomy, stretching, microdiscectomy and puncture decompression can be performed.
The life expectancy of patients depends on the cause of myelopathy and the correctness of the treatment. Thus, spinal cord injury is a serious pathology and requires complex therapy.
A source: https://OrtoCure.ru/pozvonochnik/prochee/mielopatiya.html