Acute myelopathy. Myelopathy

In the human body, the spinal cord is an integral part of the central nervous system. This organ, located in the spinal canal, is responsible for a lot of functions and the functioning of vital systems. Diseases affecting the spinal cord pose a serious danger; one of the most common pathologies is myelopathy.

In medical terminology, under the words myelopathy spinal cord refers to a whole set of different lesions of the spinal cord. This concept unites a number of pathological processes that are accompanied by dystrophic changes.
Myelopathy is not an independent pathology. The onset of the disease is preceded by a number of factors, which determine which nosological form is diagnosed in a person.
In other words, myelopathy, that is, damage to the substance of the spinal cord, can be caused by injuries and all kinds of diseases, which determine what the subsequent form of pathology will be called. For clarity of thought, let's look at simple examples:

• Ischemic – develops due to ischemia of any part of the spinal cord, that is we're talking about about blood flow disturbances.
• Diabetic – occurs against the background of diabetes mellitus.
• Alcoholism – its precursors are disorders caused by severe dependence on alcohol.

By analogy, many more examples can be given. The main idea is that it is necessary to accurately determine the form of myelopathy, because the treatment will depend on this.
The pathological process can be subacute or chronic, but in addition to this fact and the mentioned forms of the disease, it also has a greater number of types, differing in the nature of occurrence, the nature of damage to the spinal cord tissue, symptoms and treatment methods.

Causes

As mentioned earlier, the disease develops against the background of a huge number of associated factors. The main causes of the pathological process are other diseases or injuries of the spine:

• vascular atherosclerosis;
• osteoporosis;
• as a result of injury;
• infectious diseases;
• oncology (spinal cord tumors);
• circulatory disorders (ischemia, hemorrhage, etc.);
• physiological changes in the spine (scoliosis and others);
• effects of radiation on the body.

Considering such a variety of reasons that can serve as an impetus for the development of myelopathy, we can say that both young people and the elderly are susceptible to the disease.
In addition to the reasons for the development of the pathological process, one can also identify factors predisposing to the onset of the disease:

• active lifestyle with an increased likelihood of injury;
• diseases of the cardiovascular system of various etiologies;
• oncological pathologies in the body with a risk of metastasis;
• professional sports;
• advanced age;
• Spinal problems can also develop due to a sedentary lifestyle and a host of other less common factors.

Classification

According to ICD 10, the class of myelopathy diseases includes a whole group of pathological processes in which damage to the spinal cord occurs against the background of other diseases.
IN international classification myelopathy was assigned a code according to ICD 10 – G95.9 (unspecified disease of the spinal cord).
As for more detailed classification pathological process, as mentioned earlier, spinal myelopathy is divided into many separate types. In each case we are talking about a type of pathology, with its own causes of development, symptoms and other conventions. To create a complete picture of the disease, we will consider each type of pathological process separately.

Vertebrogenic

Vertebrogenic myelopathy develops due to damage to the spinal cord of different nature and severity. The main cause is all kinds of functional lesions of the spine, both congenital and acquired.
In most cases, the affected area is the thoracic or cervical spine. This is explained increased load in these areas. Regarding what exactly leads to the development of vertebrogenic myelopathy, there are a number of the most common factors:

• intervertebral hernia;
• the condition of the spinal cord worsens with osteochondrosis;
• physical damage after blows, bruises, fractures;
• any offsets intervertebral discs leading to pinching;
• vascular ischemia, provoked by their compression due to one of the points mentioned above.

There are acute and chronic form vertebrogenic myelopathy. In the first case, the disease develops rapidly due to severe damage. The second deals with sluggish pathological processes that lead to the slow development of myelopathy.

Spinal cord infarction

This type of disease is dangerous because acute disorder occurs anywhere in the spinal cord. Therefore, it is almost impossible to predict the consequences. The cause of spinal cord infarction in most cases is a blood clot; the pathology is more often observed in older people.
In this case, damage to the nerve fibers occurs, which is why you can lose sensitivity in certain parts of the body, in the limbs, and often there is a loss of muscle control, etc. With spinal cord infarction, myelopathy is accompanied by paraplegia, tetraplegia or monoplegia.

Vascular

Vascular myelopathy – pathological process, which develops as a result of circulatory disorders in the spinal cord. In most cases, we are talking about pathologies affecting the anterior and posterior spinal arteries.
Depending on the nature of the circulatory disorder, two types of vascular myelopathy are distinguished:

1. Ischemic – caused by partial obstruction of one or more vessels, which disrupts blood flow in a certain area of ​​the spinal cord. In most cases, the cause is pathologies of the spine, in which the vessels are compressed.
2. Hemorrhagic is a more severe type of disease in which the integrity of the vessel is disrupted, accompanied by hemorrhage.

Cervical

It is also often called discogenic spondylogenic myelopathy. This type of pathological process is more often observed in older people due to age-related changes bone and cartilage tissue.
Myelopathy of the cervical spine occurs when the mentioned area of ​​the spine is damaged. The main reason is compression of the spinal cord structures due to displacement of the vertebrae, the appearance of herniated vertebral discs, etc.
There is also a separate form of this type of pathology – cervical myelopathy, which is accompanied by more severe symptoms (a person may lose control of the upper limbs) and leads to disability.

Lumbar

The main difference from the previous type of disease is the location of the disease. In addition, lumbar myelopathy is accompanied by completely different symptoms and complications.
In this case, the pathological process has the same causes, but the lesions concern sensitivity lower limbs. In addition, dysfunctions may appear genitourinary system and rectum.
Damage to the lumbar vertebrae can lead to loss of control of the lower limbs and paralysis.

Thoracic and thoracic

Myelopathy thoracic The spine, as the name implies, is localized in the chest area. As for the thoracic type, we are talking about the lower part of the thoracic region. The development of the pathological process may be caused by a hernia, pinching or narrowing of the spinal canals.

Degenerative

Degenerative myelopathy is directly related to circulatory disorders due to partial obstruction of the vessels responsible for blood circulation and supplying the spinal cord.
Among the factors contributing to the development of the described ischemia, which leads to circulatory disorders, there is mainly a deficiency of vitamins E and B.
The symptoms in this case of the disease are extensive, people experience disorders motor functions starting from tremors of the limbs, and ending with a decrease in reflex abilities.

Compression and compression-ischemic myelopathy

These concepts unite a whole group of diseases that lead to the development of myelopathy in people of different ages.
Ischemic myelopathy is formed as a result of cervical spondylosis, as well as in pathologies accompanied by narrowing of the spinal canal or ischemia caused by a neoplasm.
Compressive myelopathy As the name suggests, it is caused by spinal injuries involving the spinal cord. These are severe injuries and fractures, disc protrusions. Compression is also accompanied by minor injuries in which the integrity of the blood vessels was compromised.

Spondylogenic

The pathology is localized in the cervical region. Myelopathy in this case is considered chronic. It develops as a result of a person constantly holding his head in a position that is incorrect from an anatomical point of view.
Abnormal head position syndrome occurs after injuries to the cervical spine, as well as in some neurological diseases.

Discirculatory myelopathy

Discirculatory myelopathy develops as a result of circulatory disorders in the cervicobrachial or anterior spinal arteries. In the first case Clinical signs expressed in muscle dysfunction upper limbs, in the second we are talking about disruption of the nerve centers responsible for the sensitivity of the pelvic area. The severity of the clinical picture depends on the level of vascular damage.

Discogenic

Hernias occur between the vertebrae or their bone tissue grows. In this case, the vessels in the vertebral region and the spinal cord itself are compressed, which leads to the development of discogenic myelopathy.

Focal and secondary

When it comes to focal or secondary myelopathy, the cause is usually exposure to radiation or ingestion of radioactive isotopes. This type of pathological process is characterized by special symptoms, in which the sensitivity of the skin of the hands and other parts of the body changes, the pathology is accompanied by skin rashes, ulcerations, destruction of bone tissue, etc.

Post-traumatic

The origin of this type of disease becomes clear from the name; we are talking about any injuries that affect the functions of the spinal cord. These can be blows, bruises, fractures, after which the victim is given a disability. Symptoms and consequences directly depend on the extent and level of spinal cord lesions.

Chronic

Chronic myelopathy takes a long time to develop; the symptoms are initially vague, but as the pathological process progresses, it becomes more and more pronounced.
The reasons for the development of this type of pathology are extensive:

• multiple sclerosis;
• spondylosis;
• syphilis;
• infectious diseases and much more.

Progressive

The cause of progressive myelopathy is a rare neurological disease, in which the entire half of the spinal cord is affected - Charles Brown-Séquard syndrome.
The progression of this pathology leads to weakening or paralysis of the muscles of half the body.

Symptoms

As you can guess from everything said earlier, myelopathy has the most different symptoms, it all depends on the form and type of the pathological process. However, it is possible to highlight a number common symptoms which are observed in patients in most cases:

• The first symptom is always pain in the neck or any other part, depending on the location.
• Also, the disease is often accompanied by an increase in body temperature up to 39 degrees Hg.
• For most people, regardless of the cause, a symptom of myelopathy is a feeling of weakness throughout the body, a feeling of weakness, and general malaise.
• Clinical signs are expressed in the form of dysfunction of individual parts of the body. For example, with cervical myelopathy, symptoms appear in muscle weakness and loss of control of the upper limbs.
• Very often, when the spinal cord is damaged, dysfunction of the back muscles is observed.

It is impossible to describe every symptom, there are too many of them. But remember, at the slightest muscle weakness, lack of coordination of movements, systematic numbness of the limbs, which are accompanied by general symptoms, you need to consult a doctor.

Diagnosis of the disease

Diagnostic measures are needed to accurately establish the causes, determine the nature and type of the pathological process, confirm the diagnosis and prescribe treatment.
Diagnostics involves the following actions:

• blood tests, general, biochemical;
• cerebrospinal fluid puncture.

Depending on the indications and suspicions, additional examinations may be required.

Therapy

Treatment of myelopathy is carried out mainly conservatively, it involves long-term drug therapy. In cases where the disease progresses rapidly or there is a threat to human life, it is required surgical intervention.
For complete and effective treatment, it is important to seek help as early as possible. As for methods of therapy, it involves the use of the following groups of drugs:

• combating pain with analgesics;
• reducing swelling through the use of diuretics;
• muscle spasms are relieved with muscle relaxants and antispasmodics;
• if necessary, vasodilators are prescribed, etc.

The specifics of treatment largely depend on the causes of the disease, its form, type and nature. This is why it is so important to see a doctor and undergo a full diagnosis.

Myelopathy is a common disease that occurs after spinal cord injury. Exists a large number of provoking factors, so the disease can have a different etiology.

Causes and types of lumbar myelopathy

The classification of this pathology is so confusing that even experts cannot come to a consensus. But long-term studies of the disease have given clear ideas about the causes:

1. Compression. This pathology can occur due to:
   • unsuccessful surgical interventions when reducing discs and their structural fragments;
   • disc displacement;
   • vertebral displacement as a result of spondylolisthesis;
   • formation of intervertebral hernia;
   • hemorrhages;
   • neoplasms localized near the spinal cord;
   • formation of adhesions;
   • narrowing of the spinal canal;
   • back fractures;
   • protrusion;
   • internal bleeding, etc.
2. Circulatory disorders. May occur in the background various diseases ODA and cause pathologies of the vascular system:
   • Spinal stroke.
   • Venous stagnation.
   • Congenital vascular defect (embolism, aneurysm, atherosclerosis, etc.).
3. Inflammatory reactions in the body that have a direct connection with the spinal cord. This condition can develop due to injury, infection or inflammatory processes in the various organs(myelitis, ankylosing spondylitis, tuberculosis, etc.).
4. Disturbances in metabolic processes.

New causes of pathology are gradually being added. For example, recently they added to the risk factor spinal tap. This suggests that the nature of myelopathy is not fully understood, and pathology can arise due to processes that are completely different from each other.

Most often, the cause of this somatic syndrome is osteochondrosis. Against the background of constantly progressing osteochondrosis, myelopaitis can change its character (discogenic, compression, degenerative, etc.), but this does not affect the essence of the disease, but only indicates the location.

Lumbar myelopathy is divided into several types:

1. Vertebrogenic.
2. Associated with damage to the spinal cord due to injuries or progression of pathologies, leading to compression of blood vessels. Atherosclerotic.
   • Most often associated with a blood clot or the formation of a cholesterol plaque, but it can be a consequence of hypertension, which leads to a disruption in blood circulation. In this case, specific symptoms appear:
   • numbness of the limbs;
   • speech disorder;
3. spasms and other muscle disorders.
4. Vascular.
   • With this type of pathology, there is an unpleasant tingling in the legs, numbness and loss of elasticity of the muscle corset.
   • Lumbar.
   • Characteristic only for the lumbar region and manifests itself:
5. acute lumbodynia;
6. pulling sensations in the thigh and leg area;
7. disorders in the functioning of the pelvic organs.
8. Degenerative. Associated with the development of ischemic syndrome and insufficient saturation with vitamins B and E. Compression.
9. Occurs against the background of compression of the spinal column. Often the cause is a variety of diseases of the musculoskeletal system. Spondylogenic.
10. It is a consequence of spinal injury, in which the patient cannot assume the normal anatomical position of the body.

Discogenic.

Appears in the background lasting changes in the structural elements of the spine. Most often these are ossified tissues that compress the vessels.

• Discirculatory.
• The occurrence of lumbodynia or painful sensations in certain places.
• Feeling of weakness and failures in thermoregulation.
• Irradiation of pain through internal organs.
• Disorders of the pelvic organs.
• Disturbances in the musculoskeletal system (changes in gait, lameness, etc.).
• Regular spasm of the muscular corset with limited range of motion of the lower back, etc.

The appearance of any symptoms indicates the possible development of the disease, so they cannot be ignored. The sooner treatment begins, the greater the likelihood of stopping the pathological process and restoring the body.

A simple examination is not enough to confirm the diagnosis. The patient needs to undergo a lot of tests and diagnostic studies. In a hospital setting there is a determination inflammatory process(blood tests for biochemistry). This will also show the presence infectious diseases which could lead to pathology. After this, instrumental studies are carried out:

• Cardiogram;
• CT scan;
• Radiography;
• Determination of bone mineralization density;
• Fluorography;

If a specialist suspects the presence of neoplasms, then a biopsy or culture is added to the studies cerebrospinal fluid.

Treatment of lumbar myelopathy

Conservative therapy uses not only pharmaceuticals, but also physiotherapy. On initial stage treatment, NSAIDs and analgesics are used to relieve pain syndrome. After determining the exact cause of the pathology, the doctor selects the groups of drugs necessary for the main treatment:

1. NSAIDs. Prescribed in courses if somatic syndrome is caused by inflammatory reaction . Drugs in this group eliminate inflammation, relieve swelling and normalize body temperature. IN inpatient conditions
2. injection forms are used, which bypass the body’s natural filters and quickly reach the site of inflammation. In the future, injections are replaced with tablets, ointments, capsules, emulsions, patches, etc.
3. Antibiotics. They are selected based on the sensitivity of pathogenic microorganisms. The dosage is prescribed individually and depends on age, severity of pathology and concomitant diseases.

Detoxification solutions.

• They are used in a hospital setting and lead to the removal of toxins from the body, normalization of temperature and a temporary increase in the total volume of circulating fluid.
• After eliminating lumbodynia, you can begin physiotherapeutic procedures:
• Magnetic therapy;
• Massage;
• Electrical simulation;
• Paraffin treatment, etc.

If the cause of myelopathy is an injury, then doctors select a support corset to stretch the back and restore the correct position of the discs. Only after regeneration of the vertebrae can you begin physical therapy. Before starting the exercises, you need to understand some rules:

1. Painful sensations are a signal to stop the exercise.
2. Only the attending physician or rehabilitologist should select the complex.
3. All movements are performed smoothly, without sharp turns or jolts.
4. Classes should be carried out regularly and continue even after full recovery.
5. The selection of exercises is carried out without the influence of painkillers. This will help you correctly evaluate the sensations of each exercise.
6. Better visit health complexes, in which the trainer monitors the exercises and directs them in the right direction.
7. Clothing should be loose and cover the lumbar region.

Myelopathy(Greek myelos Bone marrow, spinal cord + pathos suffering, disease) - non-inflammatory, dystrophic lesions of the spinal cord of various etiologies.

Cervical myelopathy. More often than others, the cervical spinal cord is affected due to osteochondrosis and/or spondylosis ( cervical myelopathy). Myelopathy can develop with congenital spinal stenosis, craniovertebral anomaly, injury or compression of the spinal cord by a tumor, also with cirrhosis of the liver, deficiency of vitamins B, E, Lyme disease (borreliosis), rheumatoid arthritis, as a result of chemotherapy (adriamycin, methotrexate, cytosine, vincristine), radiation therapy, epidural anesthesia or as paraneoplastic syndrome.

Atherosclerotic myelopathy. Unlike cerebral vessels, intramedullary vessels undergo atherosclerosis very rarely. Nevertheless, sufficient clinical and pathomorphological material has already been accumulated to allow us to speak of atherosclerotic myelopathy as an independent form. The histological picture is characterized by spongiosis, atrophy, necrosis and cavities in the anterior spinal artery basin, mainly at the cervical and upper thoracic level; Fibrohyalinosis of intramedullary vessels is always noted. Since motor neurons are especially sensitive to ischemia, the clinical picture of atherosclerotic myelopathy can be almost indistinguishable from amyotrophic lateral sclerosis: progressive spastic-atrophic paralysis, diffuse fasciculations, bulbar symptoms with minimal sensory defects. The disease mainly affects elderly and senile people.

Carcinomatous myelopathy- one of the manifestations of paraneoplastic damage to the nervous system; Clinically, it is so reminiscent of amyotrophic lateral sclerosis that some researchers consider carcinomatous myelopathy to be a special form of amyotrophic lateral sclerosis of a carcinomatous nature. The cerebrospinal fluid is either unchanged or has moderate hyperalbuminosis and pleocytosis. In some cases, carcinomatous myelopathy proceeds like subacute necrotizing myelitis (see full body of knowledge).

Post-traumatic myelopathy. After damage to the spinal cord, spinal syndrome develops of varying severity, which manifests itself as paralysis, sensitivity disorders, pelvic disorders and remains stable throughout the patient’s subsequent life. However, in a small proportion of cases, this residual symptom complex exhibits a progressive course: segmental loss of sensitivity appears, sometimes of a peripheral type. In terms of clinical presentation and course, this syndrome resembles syringomyelia (see full body of knowledge). The pathogenesis of the progressive course of post-traumatic myelopathy is unclear; some researchers suggest that it is based on chronic pachymeningitis, leading to compression of the blood vessels supplying the spinal cord.

Toxic myelopathy occurs very rarely during intoxication with lead, mercury, copper, arsenic and relatively more often during poisoning with orthocresyl phosphate. An indication of involvement of the spinal cord in the process is the appearance of loss of conductive sensitivity against the background of specific polyneuropathy (see full body of knowledge).

Radiation myelopathy. Damage to the spinal cord at the cervical level has been described, which can occur in a small proportion of patients at various times after radiation therapy for cancer of the larynx or pharynx when high doses of radiation are used. Pathomorphological substrate Myelopathy is necrosis of the spinal cord due to obliteration of the spinal arteries. Clinical, the picture is formed slowly. Along with signs of damage to the cervical spinal cord long time Brown-Séquard syndrome may also persist (see full body of knowledge Brown-Séquard syndrome). The composition of the cerebrospinal fluid was not changed. Usually, in order to differentiate myelopathy from tumor metastasis, it should be borne in mind that cancer of the larynx and pharynx very rarely metastasizes to the spine. In addition, compression of the spinal cord during metastasis leads to the development of gross spinal lesions much faster than Myelopathy. Protein-cell dissociation in the cerebrospinal fluid, identification of a block in its circulation pathways during the Queckenstedt test and characteristic myelography data indicate the presence of metastasis.

Causes of Myelopathy

Cervical myelopathy occurs predominantly in middle-aged and elderly people. Most people develop changes (spondylosis and/or osteochondrosis) with age cervical spine spine, however, only in isolated cases does myelopathy occur, the genesis of which is assumed to be compression of the spinal cord or its vessels by posterior osteophytes, thickened ligamentum flavum, or herniated intervertebral discs.

Myelopathy symptoms

The spinal cord is the main "cable" of the nervous system, connecting the brain to the body. If this cable malfunctions, the connection between the brain and the body is disrupted, which can lead to the following symptoms:

1. Decreased muscle strength in the arms and/or legs(paralysis, paresis) below the site of spinal cord injury. Does not always coincide with sensory impairment.
2. Sensory impairment below the site of spinal cord injury. It is possible to decrease or increase only one type of sensitivity (pain, tactile, temperature, muscle-articular sensation) or all types of sensitivity.
3. Disruption Bladder and intestines(pelvic disorders). Incontinence or difficulty emptying the bladder and bowels may occur.
4. Tension in the muscles of the legs and sometimes the arms (spasticity). This is due to the brain's control of the spinal cord being switched off. Nerve cells the spinal cord autonomously tenses the muscles of the limbs. The legs are characterized by forced flexion of the knee and plantar flexion of the foot. For the arms - forced bending in elbow joint and fingers.

The disease usually develops gradually. Many patients experience pain and limited movement in the cervical spine. Spastic paresis and impaired deep sensitivity in the legs are typical, combined with peripheral paresis in the arms. Lhermitte's symptom is often observed: a sensation of passing electric current along the spine with irradiation to the arms and/or legs when flexing or extending the neck. In rare cases, dysfunction occurs pelvic organs. In many patients, myelopathy is combined with cervical radiculopathy. When examining a patient, the results of spondylography and MRI are important, as they allow not only to identify spondylosis and/or herniated intervertebral discs at the cervical level with spinal cord deformation, but also to exclude other possible causes of spinal cord compression (spinal cord tumor, craniovertebral anomaly, etc. ). Unlike amyotrophic lateral sclerosis, spondylogenic myelopathy does not have bulbar disorders (dysphagia, dysphonia, dysarthria), diffuse fasciculations, or characteristic changes on needle electromyography, but sensory disorders are common, with typically slow progression of the disease.

Diagnostics

The most informative are MRI and myelography. The composition of the cerebrospinal fluid is normal. A significant role is played by spondylography, which allows, in particular, to identify a critical decrease in the sagittal diameter of the spinal canal. Differential diagnosis carried out with a tumor, sarcoidosis, spinal form of multiple sclerosis, arteriovenous malformations of the spinal cord, funicular myelosis, hereditary (familial) spastic paraplegia of Strumpel.

Myelopathy treatment

Treatment is symptomatic. For discogenic myelopathy, if evidence of spinal cord compression is detected, decompressive laminectomy is performed.

The prognosis for recovery is usually poor. However, for the most common cervical discogenic myelopathy, surgery can stabilize the process and even lead to significant improvement.

Treatment of vertebrogenic myelopathy is based on immobilization of the cervical spine (wearing a cervical corset), physiotherapeutic procedures (electrophoresis, ultrasound, massage, etc.), use of NSAIDs for pain, as well as vasoactive and metabolic drugs. In cases where conservative therapy is ineffective and there is an increase in symptoms of the disease with significant motor and sensory disorders, it is recommended surgery- decompressive surgery at the cervical level.

Myelopathy is a neurological pathology of the spine in which damage to the spinal cord is observed.

This disease manifests itself in the form of sensory disturbances, deterioration of motor activity, and conduction problems. Symptoms of pathology directly depend on the form of the disease. Treatment should be selected by a doctor taking into account individual characteristics the patient's body.

Causes

Since myelopathy is characterized by disruption of the spinal cord, there are following reasons appearance of this disease:

• compression - may be the result of a tumor formation, hernia, or vertebral displacement;
• problems with blood circulation - in this case, narrowing or blockage of the vessel occurs, spinal cord ischemia;
• traumatic injuries - severe bruises or fractures, complications of surgical interventions;
• inflammatory damage to the spinal cord or vertebrae;
• consequences of spinal puncture;
• deficiency of certain vitamins – in this case develops degenerative myelopathy.

Classification

There are many types of the disease, each of which has certain characteristics. Thus, vertebrogenic myelopathy develops when the spine is damaged. The following factors lead to its appearance:

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• compression by the contents of the bone canal;
• damage to the blood vessels of the back;
• injuries.

If vertebrogenic myelopathy becomes chronic, the symptoms of the disease increase gradually.
Another type of pathology is spinal cord infarction. This disease may be a consequence arterial hypotension, in which the blood supply to certain areas deteriorates. Sometimes the cause of the pathology is blood clots in small vessels, as a result of which the ischemic form of the disease develops.
As a result of such processes, limbs are weakened, a person loses motor activity, he may experience speech impairment and decreased sensitivity.
Vascular myelopathy is chronic illness, which is a consequence of osteochondrosis, traumatic injuries, and disturbances in the functioning of blood vessels. With the development of this disease, weakness and increased fatigue of the legs occur.
A fairly common disorder is cervical myelopathy. The spondylogenic form of damage to this department affects the functioning of the musculoskeletal system. Its symptoms include stiffness of the limbs in older people. As the body ages, the discs lose water, causing them to shrink and fragment.

Cervical cervical spinal myelopathy is considered the most dangerous disease, since it leads to negative consequences. In this case, chronic compression of the spinal cord is observed. Therefore, cervical myelopathy provokes symptoms of muscle weakness in the limbs.
Involvement of the thoracic region is quite rare. This disease is usually the result intervertebral hernia. The structure of the thoracic region is such that only 1% of such lesions are localized in this area of ​​the spine.
By virtue of anatomical features treatment of such myelopathy presents certain difficulties - this usually requires surgical intervention. Thoracic myelopathy is often mistaken for tumors.
Damage to the lumbar region has characteristic symptoms:

1. When the spinal cord is compressed between the first lumbar and tenth thoracic vertebrae, epiconus syndrome develops. It is accompanied by pain in the lumbar spine, back of the leg and thighs. There is also weakness in the limbs.
2. This disease is characterized by paresis of the feet, decreased muscle tone in the buttocks, and decreased muscle strength in the lower leg. This syndrome is accompanied by loss of plantar and Achilles reflexes.
3. If the compression is localized at the level of the second lumbar vertebra, conus syndrome occurs. Wherein painful sensations are not too strong, but problems arise in the functioning of the genitourinary system and intestines. This syndrome is accompanied by a decrease in sensitivity in the anogenital area.
4. With compression at the level of the second lumbar root and discs that are localized below the vertebrae, cauda equina syndrome appears. In this case, intense pain occurs in the lower part of the body, which radiates to the limbs. This syndrome can also cause paralysis.

Degenerative myelopathy develops as a result of gradually increasing ischemia of the spinal cord. It may be a consequence of a deficiency of vitamins E and B12. Degenerative myelopathy requires special treatment, which consists of replenishing the lack of these substances.
The compression-ischemic form of the disease includes a number of pathologies:

• cervical spondylosis;
• narrowing of the spinal canal;
• tumor lesion;
• hemorrhage;
• internal bleeding.

Also, the compression-ischemic form of the disease can be a consequence of acute traumatic injury. It may be accompanied by vertebral displacement or a back fracture. In addition, compression-ischemic myelopathy can be triggered by acute protrusion of the spinal disc.

Symptoms

This disease may have various symptoms– it all depends on the form of the pathology and the reasons that provoked its development.
Moreover, the general clinical picture in each case is the same. First, pain occurs in the affected area of ​​the spine, after which specific symptoms neurological nature:

• decreased sensitivity of the skin;
• decreased muscle strength in the affected area;
• difficulty performing voluntary movements;
• disruption of the pelvic organs - characteristic of damage to the lumbar spine.

With the development of cervical myelopathy, the following symptoms occur:

• • decreased hand strength;

• severe pain at the level of the neck, back of the head, between the shoulder blades;
• involuntary twitching in the arms, muscle spasms;
• numbness skin at the level of the neck or arms.

When the thoracic region is affected, the following manifestations may occur:

• pain in the heart area;
• pain in the rib area;
• weakness in the arms;
• spasms and tingling in the arms, back and chest.

Diagnostics

To pick up effective treatment, need to be given Special attention carrying out diagnostics. Magnetic resonance imaging is used to visualize the spinal cord, intervertebral discs and tumor formations. The same study allows you to determine the areas of spinal stroke.
Computed tomography is used to assess the condition of the bones of the spine. Computed angiography helps examine blood vessels by injecting a contrast agent.
Electromyography is used to assess the conduction of electrical stimulation along nerve fibers. A blood test is used to identify infectious, autoimmune and metabolic diseases.

Treatment

Spinal myelopathy is considered a rather complex disease, but today there are many types effective therapy. Treatment of the pathology depends on the causes of its development.

If a person develops degenerative myelopathy, he is prescribed antioxidants and B vitamins. For other types, vasodilators and neuroprotectors can be used.
In addition, it is important to consider that treatment depends on the form of the disease:

1. Exacerbation of osteochondrosis is treated with analgesics and non-steroidal anti-inflammatory drugs. After elimination severe pain treatment is carried out using physiotherapy, massage, exercise therapy.
2. Multiple sclerosis requires the appointment of appropriate medicines, including steroids.
3. To cope with infections, antibacterial and antipyretic drugs are prescribed. In some cases, treatment is done with steroids.
4. If myelopathy is the result of compression, surgical treatment may be required to remove the tumor or hernia.

Myelopathy – quite serious illness spine, which can lead to negative health consequences. To prevent this from happening, you need to start treating the disease as early as possible.

Cervical myelopathy is a complex of symptoms, the appearance of which is associated with damage to the spinal cord at the level of the cervical spine. In medicine, this term usually refers to chronic non-inflammatory processes in the spinal cord. Myelopathy can occur in any part of the spinal cord, but most often it occurs in the cervical and lumbar regions. Myelopathy cannot be called a separate disease. This is a collective concept denoting a group of signs of damage to some part of the spinal cord. It can be a consequence of many other diseases, primarily osteochondrosis. You will learn about when cervical myelopathy occurs and how it is characterized in this article.

Myelopathy is a chronic process. This means that sudden “problems” with the activity of the spinal cord do not apply to it. Most often, myelopathy is the result of degenerative processes in the spine. This condition occurs slowly, gradually, over time acquiring more and more new symptoms. Its first signs are far from specific (for example, neck pain), so it is not always possible to suspect this condition right away. What can cause cervical myelopathy? Let's look at this issue in more detail.

When does cervical myelopathy occur?

Speaking in general about possible reasons appearance of myelopathy, there are quite a lot of them. But among them there are those that make up up to 90% of all cases. These are the following states:

• cervical spondylosis;
• stenosis (narrowing) of the spinal canal.

These three degenerative diseases account for the lion's share in the genesis of myelopathy. More often they cause myelopathy in elderly patients. In osteochondrosis with herniation, a disc protruding into the lumen of the spinal canal begins to compress the structures of the spinal cord or the vessels feeding it, which leads to the occurrence of myelopathy. Cervical spondylosis in the form of pathological bone growths along the edges of the vertebral bodies (osteophytes) also causes compression of various parts of the spinal cord. Spinal stenosis can be congenital, or it can appear as a result of osteochondrosis, spondylosis, trauma or surgery on the spine. In these cases, compression of the spinal cord also occurs in its canal, which leads to disruption of its function.

Myelopathy can also occur in a number of other diseases, but this is much less common than in the cases described above. Such diseases include:

• rheumatoid arthritis;
• systemic lupus erythematosus;
• cirrhosis of the liver;
• and nearby structures;
• disturbances in the structure of the junction of the spine and the skull (anomalies of the craniovertebral junction);
• AIDS;
• chronic alcoholism;
• complications of chemotherapy and radiation therapy.

These processes somehow lead to disruption of the normal functioning of the spinal cord. Nerve impulses do not pass or partially pass through the neurons of the spinal cord, so the lower parts of the spinal cord do not receive the correct information. Accordingly, the work of everything innervated by the lower-lying departments is disrupted. And since the cervical spinal cord is located at the very top, with cervical myelopathy problems arise with the activity of the entire spinal cord. Clinically, this is reflected in the appearance of symptoms in the upper and lower extremities and pelvic organs. Now let's look at the symptoms that characterize cervical myelopathy.

Symptoms of cervical myelopathy

The main symptoms of cervical myelopathy are:

• pain in the neck and shoulder girdle;
• limited mobility in the cervical spine;
• pain radiating to the arms in the form of “shooting” along the outer or inner surface of the arm. Such pain may intensify when coughing or straining;
• feeling of numbness in one or both arms;
• decreased sensitivity in one or both arms and legs (tactile, pain, temperature sensitivity);
• crawling sensation (paresthesia) in the arms and legs (mainly hands and feet);
• weakness in the muscles of the arms and legs;
• decreased reflexes from the upper extremities and increased reflexes from the lower extremities;
• increased muscle tone in the legs and decreased muscle tone in the arms;
• pathological foot reflexes (Babinsky, Oppenheim and others);
• foot clonus (when, in a lying position, after plantar flexion of the foot, the doctor sharply extends it, as a result of which the foot repeatedly makes swinging movements);
• loss of deep sensitivity mainly in the legs (vibration is not felt, the patient cannot determine with closed eyes the point of contact on the legs, indicate which finger the doctor touches and in which direction the doctor bends or straightens it);
• a sensation of electric current passing through the spine, arms and legs when flexing or extending the neck (Lhermitte's sign);
• for a long time existing process the appearance of disorders of the pelvic organs (loss of control over urination and defecation), loss of weight in the muscles of the arms and legs is possible.