What are spinal cord disorders? Treatment of spinal cord injuries. Compression diseases of the spinal cord

Spinal cord disease is large group various pathologies that differ in some ways. Spinal cord located in the center spinal column plays an important role in the nervous system. Therefore, it is important to know the diseases themselves, their symptoms and start therapy on time.

Diseases of the spinal cord have a lot of symptoms. This organ is divided into specific segments that are associated with a specific pair nerve endings. Each such pair is fully responsible for the work certain bodies. The fibers of the gray matter are crossed, it is for this reason that the pathology on the left side is a direct violation on the right.

The tissue of the spinal cord is made up of two elements: gray matter (nerve cells) and white matter(sprouts). Its length is approximately 45 cm, it regulates all the functions of the body, and its work occurs through the transmission of impulses.

Symptoms may varying degrees. The mildest of them are considered dizziness and nausea, as well as soreness in the muscles, which appears periodically. Depending on the intensity of the sensations, the condition may worsen.

Frequent and dangerous signs considered movement disorders, that is, restriction of movement by complete or partial paralysis. This is accompanied by an increased tone in muscle tissue. Usually such violations are symmetrical, but in some cases there may be exceptions.

Violation of sensitivity depends on the location of the disease and its degree. It can be superficial, temperature or painful. Vegetative disturbances are accompanied high temperature and heavy sweating. At the same time, metabolism is disturbed, the nature of stool and urination changes. When the nerves are pinched, the pain symptoms go into the hands. If there is a lesion of the lower back, then the pain will be felt in the lower extremities.

In addition to the main symptoms that accompany the disease, it can be expressed in:

• uncontrolled bowel movements;
• soreness in the muscles;
• muscle atrophy.

Compression diseases of the spinal cord

Some pathologies can cause compression of the spinal canal, which is called compression. In this case, the functions of this organ are always violated. This process can cause diseases such as otitis, sinusitis. With their long course, meningitis and encephalitis appear. Also, the risk of compression has hemorrhages that occurred due to injuries or problems with the walls of blood vessels. In addition, tumors, osteochondrosis, hernia and arthritis are dangerous.

brain tumors

Absolutely any neoplasms in the spinal cord are dangerous, therefore, more importance is given not to malignancy, but to the location of the tumor. Usually, three groups of such formations are distinguished - extradural, intradural and intramedullary.

Extradural are the most dangerous and progress faster than others. They appear in the vertebrae or hard tissue of the brain. Intradural arise under the hard tissue of the membrane of the spinal cord. Intramedullary are located in the brain itself.

Tumors are treated only with the help of an operation, which is not always successful. Restorative therapy is prescribed only after a successful surgical intervention, otherwise it will be ineffective.

Intervertebral hernia

The most common among all diseases in the back are intervertebral hernia. Initially, a protrusion is formed, and only after a while a hernia occurs due to the fact that the fibrous ring ruptures, which performs the fixing function of the disc core.

After a rupture occurs, all the fluid begins to flow out and, most often, it enters the spinal canal. If the disease affects the spinal cord, myelopathy (destruction of the substance of the spine) begins to develop.

There are cases when the disease does not manifest itself in any way, and the patient feels great, but when the spinal cord is involved in the disease, the following symptoms appear:

• soreness in the affected area;
• sensitivity change;
• loss of control over limbs;
• weakness;
• violation of the work of internal organs;
• the pain extends from the loins to the kneecap.

These signs appear when the hernia reaches a huge size. For treatment, a therapeutic effect is used, with the use of medications and physiotherapy.

Radiation and paracarcinomatous myelopathy are considered diseases that are difficult to distinguish. MRI shows severe swelling of the spinal cord, which is treated with radiation therapy.

Necrotic myelopathy at the time of exacerbation affects several departments in the spinal canal at the same time. The reason for this is strong cancerous growths, which are accompanied by inflammation. Patients may experience partial or complete paralysis, possible violations pelvic organs.

Carcinomatous meningitis arises from carcinoma. In some cases, it does not cause myelopathy, provided that the divergence of the nerve roots does not develop, which cause infiltration of the spinal canal and provoke aggravated compression.

The cause of a heart attack is often a severe violation of the spinal circulation, which results in a severe malfunction of the spinal cord, since blood flows to it with great difficulty. This can happen in any spinal region. In the one that is more affected, a heart attack develops.

Most often, it is very difficult to determine the true cause of a heart attack. But the most common is the formation of blood clots in small blood vessels. They supply blood to the spinal cord even when the extravertebral arteries are affected.

Most often, such a violation affects people over the age of 50, and in patients under the age of 40, a heart attack occurs with pathologies of the aorta and vasculitis.

The development of a heart attack occurs during the formation of thrombosis or at the time of aortic dissection. But it can also appear for other reasons - with arteritis and serum sickness. Ischemic infarction general type often caused by impaired spinal circulation or myeloischemia. When a heart attack occurs, several departments are affected at once.

The cause for the development of a heart attack can be a minor injury, for example, during sports. In this case, it is caused by a breakaway from a hernia intervertebral disc microparticle.

Symptoms of diseases of the spinal cord are very diverse. There is severe pain in the back, sensitivity decreases, both pain and temperature. In some cases, bilateral flaccid paralysis of the limbs occurs. Signs of a spinal infarction are constant pain in the head, nausea and weakness, which are accompanied by fainting.

Inflammatory myelopathy

Diseases of the spinal cord can activate the inflammatory process. This syndrome usually develops over several days or weeks. The most common cause is an infectious disease.

If myelitis worsens, the patient complains of pain in the back and severe weakness in the muscular corset, which develops very quickly. In addition, the appearance of paresthesia in the lower extremities is possible.

When the spinal cord is affected by a virus, specific types of myelitis can occur. common cause disease becomes herpes zoster.

Another disease is arachnoiditis - an inflammatory process in the spinal cord and brain. It is he who strikes the arachnoid membrane. There are many reasons for its appearance. These are diseases of various types and severity, trauma and inflammation in the sinuses. When prescribing treatment, the infectious source is first eliminated, for this antibiotics and various therapies are prescribed.

Chronic myelopathy

Diseases of the chronic type can be localized in different areas and manifest themselves in different ways.

One common cause is spondylosis. It is dangerous because it can cause severe changes in the intervertebral discs. These disorders cause compression deviations in the spinal cord and nerve roots. It can be localized in the thoracic, cervical and lumbar regions.

Spondylosis causes salt deposits, and they significantly narrow the canals of the spinal column and the holes between the vertebrae. Its complication is the formation of hernias between the vertebrae.

The disease itself is the next stage in the development of osteochondrosis and actively progresses with poor nutrition of the spine, injuries and physical exertion. This disease is distributed among the male population over 40 years of age. key symptom is soreness after exertion, hypothermia and with sudden movements. In some cases, the movement of the spinal column may be limited.

Treatment is prescribed depending on the degree and symptoms of spinal cord disease, but it is always complex and is aimed at slowing down the course of the disease, relieving pain and symptoms, and preventing possible complications. They use massage, physiotherapy and medicines.

Another chronic disease is lumbar stenosis. The disease causes a narrowing of the central canal in the spinal column, resulting in compression in the spine and nerve endings. Pathology is divided into two types:

• congenital stenosis. It appears due to a narrow passage in the spinal canal and certain features of the vertebrae and their anomalies.
• Acquired stenosis. It is caused by displacement of the vertebrae or their reduction, which occurred after an injury. The disease can cause tumors, disc protrusions, or herniation.

Diagnosis of the disease is carried out using MRI. Used for treatment conservative method and in some cases surgery is possible.

Vascular diseases

Spinal cord vascular disease is caused by disorders in the vascular system. They can develop with a compression lesion or at the time of a change in the walls, as well as with congenital anomalies.

There are cases when the cause of vascular abnormalities are anomalies in the structure of the capillaries themselves, as well as disturbances in the venous beds. Such deviations may not manifest themselves for many years. They progress in different ways.

Treatment of these diseases is prescribed with extreme caution, and only after a complete examination with an accurate diagnosis. Incorrectly chosen methods for the treatment of spinal cord disease can cause a worsening of the condition. In such cases, the disease begins to actively progress.

In addition to the standard complex treatment in some cases, surgery is required surgical intervention which restores blood circulation in the spinal cord.

If the examination revealed acute or complicated abnormalities in the circulatory and vascular system, then a further examination is carried out at the same time, repeated tests and drugs are prescribed that will relieve symptoms and improve the general condition of the patient.

Deviations in the spinal cord, if not started timely treatment, may cause serious complications. It is unacceptable to engage in self-treatment in this case, as the condition can worsen. It is recommended to undergo a full examination, establish the true causes of the disease and begin treatment, which in some cases is prescribed individually.

The spinal cord belongs to the central nervous system. It is connected to the brain, nourishes it and the shell, transmits information. The main function of the spinal cord is to correctly transmit incoming impulses to other internal organs. It consists of various nerve fibers through which all signals and impulses are transmitted. Its basis is white and gray matter: white is made up of processes of nerves, gray contains nerve cells. The gray matter is located in the core of the spinal canal, while the white matter completely surrounds it and protects the entire spinal cord.

Spinal cord diseases are all characterized by a great risk not only for health, but also for human life. Even minor deviations of a temporary nature sometimes cause irreversible consequences. Thus, incorrect posture can doom the brain to starvation and trigger a number of pathological processes. It is impossible not to notice the symptoms of disorders in the functioning of the spinal cord. Almost all the symptoms that can be caused by diseases of the spinal cord can be classified as severe manifestations.

The mildest symptoms of spinal cord disease are dizziness, nausea, periodic pain in muscle tissue. The intensity in diseases can be moderate and variable, but more often the signs of damage to the spinal cord are more dangerous character. In many ways, they depend on which particular department has undergone the development of pathology and what disease is developing.

Common symptoms of spinal cord disease:

• loss of sensation in a limb or part of the body;
• aggressive back pain in the spine;
• uncontrolled emptying of the bowels or bladder;
• loss or limitation of movement;
• severe pain in the joints and muscles;
• paralysis of the limbs;
• amyotrophy.

Symptoms may vary depending on which substance is affected. In any case, signs of damage to the spinal cord cannot be overlooked.

The concept of compression means a process in which squeezing, squeezing the spinal cord occurs. This condition is accompanied by multiple neurological symptoms which can cause some diseases. Any displacement or deformation of the spinal cord always disrupts its functioning. Often, diseases that people consider safe cause severe damage not only to the spinal cord, but also to the brain.

So, otitis media or sinusitis can cause an epidular abscess. In diseases of the ENT organs, the infection can quickly enter the spinal cord and provoke infection of the entire spinal column. Quite quickly, the infection reaches the cerebral cortex and then the consequences of the disease can be catastrophic. At severe course otitis, sinusitis, or with a long phase of the disease, meningitis and encephalitis occur. The treatment of such diseases is complex, the consequences are not always reversible.

Hemorrhages in the region of the spinal cord are accompanied by storm pains throughout the spine. This happens more often from injuries, bruises, or in case of a serious thinning of the walls of the vessels surrounding the spinal cord. Locality can be absolutely any, more often the cervical region suffers as the weakest and most unprotected from damage.

The progression of a disease such as osteochondrosis, arthritis can also cause compression. Osteophytes, as they grow, put pressure on the spinal cord, intervertebral hernias develop. As a result of such diseases, the spinal cord suffers and loses its normal functioning.

As in any organ of the body, tumors can appear in the spinal cord. It is not even malignancy that matters, since all tumors are dangerous for the spinal cord. The value is given to the location of the neoplasm. They are divided into three types:

1. extradural;
2. intradural;
3. intramedullary.

Extradural are the most dangerous and malignant, have a tendency to rapid progression. Occur in the hard tissue of the brain membrane or in the vertebral body. The surgical solution is rarely successful, associated with a risk to life. This category also includes tumors of the prostate and mammary glands.

Intradural are formed under the hard tissue of the lining of the brain. These tumors are neurofibromas and meningiomas.

Intramedullary tumors are localized directly in the brain itself, in its main substance. Malignancy is critical. For diagnosis, MRI is used more often as a study that gives a complete picture of spinal cord carcinoma. This disease is treated only surgically. All tumors have one thing in common: conventional therapy has no effect and does not stop metastases. Therapy is appropriate only after a successful operation.

Intervertebral hernias occupy a leading position in a number of diseases of the spinal cord. Primary protrusions are formed, only over time it becomes a hernia. With such a disease, deformation and rupture of the fibrous ring occurs, which serves as a fixator for the disc core. As soon as the ring is destroyed, the contents begin to flow out and often end up in the spinal canal. If the intervertebral hernia has affected the spinal cord, myelopathy is born. Illness means dysfunction of the spinal cord.

Sometimes the hernia does not manifest itself and the person feels normal. But more often the spinal cord is involved in the process and this causes a number of neurological symptoms:

• pain in the affected area;
• sensitivity change;
• depending on the locality, loss of control over the limbs;
• numbness, weakness;
• violations in the functions of internal organs, more often the pelvis;
• the pain spreads from the waist to the knee, capturing the thigh.

Such signs usually manifest themselves, provided that the hernia has reached an impressive size. Treatment is often therapeutic, with the appointment of drugs and physiotherapy. An exception is only in cases where there are signs of failure in the work of internal organs or in case of serious damage.

Non-compressive myelopathy refers to complex diseases spinal cord. There are several varieties, but it is difficult to distinguish between them. Even MRI does not always accurately establish the clinical picture. The CT scan results always show the same picture: severe swelling of the tissues without any signs of compression of the spinal cord from the outside.

Necrotizing myelopathy involves several segments of the spine. This form is a kind of echo of significant carcinomas, removed by localization. Over time, it provokes the birth of paresis and problems with the pelvic organs in patients.

Carcinomatous meningitis is found in most cases when the body has a progressive cancer tumor. Most often, primary carcinoma is located either in the lungs or in the mammary glands.

Prognosis without treatment: no more than 2 months. If the treatment is successful and on time, the life span is up to 2 years. Most of the deaths are associated with running processes in the CNS. These processes are irreversible, brain function cannot be restored.

Inflammatory myelopathy

Most often, arachnoiditis is diagnosed as one of the types of inflammatory process in the brain or spinal cord. It must be said that such a diagnosis is not always correct and clinically confirmed. A detailed and qualitative examination is required. Occurs against the background of transferred otitis, sinusitis or against the background of severe intoxication of the whole organism. Arachnoiditis develops in the arachnoid membrane, which is one of the three membranes of the brain and spinal cord.

A viral infection provokes a disease such as acute myelitis, which is similar in symptoms to those of other inflammatory diseases of the spinal cord. Diseases such as acute myelitis require immediate intervention and identification of the source of infection. The disease is accompanied by ascending paresis, severe and growing weakness in the limbs.

Infectious myelopathy is expressed more specifically. The patient cannot always understand and correctly assess his condition. More often, the cause of infection is herpes zoster, the disease is complex and requires long-term therapy.

spinal cord infarction

For many, even the concept is as unfamiliar as a spinal cord infarction. But because of severe violation blood circulation, the spinal cord begins to starve, its functions are upset so much that it entails necrotic processes. There are blood clots, the aorta begins to exfoliate. Almost always several departments are affected at once. A vast area is covered, a general ischemic infarction develops.

Even a minor bruise or injury to the spinal column can be the cause. If there is already an intervertebral hernia, then it can collapse in case of injury. Then its particles enter the spinal cord. This phenomenon is unexplored and poorly understood, there is no clarity in the very principle of the penetration of these particles. There is only the fact of detection of particles of the destroyed tissue of the nucleus pulposus of the disc.

It is possible to determine the development of such a heart attack according to the patient's condition:

• sudden weakness to failure of the legs;
• nausea;
• temperature drop;
• Strong headache;
• fainting.

Diagnosis only with the help of MRI, treatment is therapeutic. A disease such as a heart attack, it is important to stop it in time and stop further damage. The prognosis is often positive, but the quality of life of the patient may worsen.

Osteochondrosis is recognized as a killer of the spinal column, its diseases and complications can rarely be reversed to a tolerable state. This is due to the fact that 95% of patients never carry out prophylaxis, do not visit a specialist at the onset of the disease. Seek help only when the pain does not allow to live. But at such stages, osteochondrosis already triggers processes such as spondylosis.

Spondylosis is the end result of degenerative changes in the structure of spinal cord tissues. Violations cause (osteophytes), which ultimately compress the spinal canal. The pressure can be strong and cause stenosis of the central canal. Stenosis is the most dangerous condition, for this reason a chain of processes can start that involve the brain and central nervous system in the pathology.

Treatment of spondylosis is often symptomatic and is aimed at alleviating the patient's condition. The best result can be accepted if in the end it is possible to achieve a stable remission and delay the further progression of spondylosis. It is impossible to reverse spondylosis.

Lumbar stenosis

The concept of stenosis always means squeezing and narrowing of some organ, channel, vessel. And almost always stenosis poses a threat to human health and life. Lumbar stenosis is a critical narrowing of the spinal canal and all its nerve endings. The disease can be both congenital pathology and acquired. Stenosis can be caused by many processes:

• osteophytes;
• displacement of the vertebrae;
• hernia;
• protrusions.

Sometimes a congenital anomaly worsens an acquired one. Stenosis can be in any department, it can cover part of the spinal column, and the entire spine. The condition is dangerous, the solution is often surgical.

Signs and symptoms: The main clinical signs of diseases of the spinal cord are: loss of sensitivity below a certain level ("level of sensitivity disorders"), accompanied by muscle weakness and spasticity of the limbs.

Sensitivity disorders: Frequent paresthesia; they may develop in one or both feet and spread upward. The level of disorders of pain or vibration sensitivity often coincides with the localization of the level of transverse lesions of the spinal cord.

Movement disorders: Rupture of the corticospinal tracts causes quadriplegia or paraplegia with increased muscle tone, increased deep tendon reflexes, and positive Babinski's sign.

Segmental signs: There are indicative indicators of the level of damage, for example, a band of hyperalgesia or hyperpathy, a decrease in tone and atrophy of individual muscles with loss of tendon reflexes.

Vegetative dysfunctions: First, urinary retention, which should raise the suspicion of a disease of the spinal cord, when combined with spasticity and (or) sensitivity disorders at a certain level.

Pain: Midline back pain has diagnostic value for localizing the level of the lesion; pain between the shoulder blades can be the first sign of compression of the spinal cord at the level of the middle part thoracic spine; radicular pain may indicate a more laterally located lesion; pain that occurs when the lower spinal cord (medullary cone) is affected may radiate to the lower back.

Lesions at or below the level of L 4 vertebrae: The defeat of the cauda equina (cauda equina) causes the development of flaccid asymmetric paraparesis with the absence of reflexes, dysfunction of the bladder and rectum, loss of sensitivity from the L level; pain usually radiates to the perineum or thighs. The defeat of the medullary cone does not cause pain, but entails an earlier manifestation of symptoms of dysfunction of the bladder and rectum. Compression damage to the cone and cauda equina at the same time (cauda equina) can cause the combined development of signs of damage to peripheral motor neurons and hyperreflexia or a positive Babinski reflex. (This combination of symptoms is usually observed with lesions not only of the cauda equina and cone, but also of the spinal cord at the level of the lumbar enlargement. Note. ed.).

Lesions at the level of foramen magnum: In typical cases muscle weakness shoulder and arm is accompanied by ipsilateral, and then contralateral leg and, finally, the contralateral arm; the presence of Horner's syndrome suggests a lesion cervical.

Extramedullary lesions: Accompanied by radicular pain, Brown-Séquard syndrome, signs of asymmetric segmental lesions of the lower motor neurons, early corticospinal signs, sacral loss of sensation, early manifestations of CSF pathology.

Intramedullary lesions: Accompanied burning pains, the localization of which is difficult to determine, the loss of pain sensitivity with a preserved sense of the position of the joint, with the preservation of perineal and sacral sensations, less pronounced corticospinal signs; CSF is normal or with minor abnormalities.

Etiology:

Spinal cord compression:1. Tumors of the spinal cord: primary or metastatic, extra- or intradural; most of them are epidural metastases from adjacent vertebrae; the most frequent malignant tumors affect the prostate gland, chest, lungs, lymphomas, plasmacytic dyscrasias; The first symptom is usually back pain that worsens when lying down, with pain points, this symptom precedes other symptoms by many weeks.

2. Epidural abscess: initially, fever of unknown etiology with aching spinal pain and tender points, then radicular pain develops; shortly after the development of neurological symptoms, compression of the spinal cord rapidly increases.

3. Spinal epidural hemorrhage and hematomyelia: manifests as an acute transverse myelopathy that develops within minutes or hours against the background of severe pain. Reasons: minor trauma, lumbar puncture, anticoagulant therapy, hematological disorders, arteriovenous anomalies, hemorrhage into the tumor. The etiology of most of these disorders is not clear.

4. Acute protrusion of the intervertebral disc: the formation of a herniated disc in the cervical and thoracic regions is less common than in the lumbar (see Chapter 5).

5. Acute trauma with spinal fracture or dislocation: may not present with myelopathy until mechanical pressure will not cause further displacement of the destabilized spine.

6. Chronic compression myelopathy: a) cervical spondylosis; b) constriction spinal canal at the lumbar level: intermittent and chronic compression of the cauda equina (cauda equina) associated with congenital narrowing of the lumbar canal and provoked by disc protrusion or spondylitis.

Non-compressive neoplastic myelopathy. Intramedullary metastases, paracarcinomatous myelopathy, complications after radiation therapy.

Inflammatory myelopathy

1. Acute myelitis, transverse myelitis, necrotizing myelopathy: the disease develops within a few days with the manifestation of sensitive and motor symptoms often involving the bladder. May be the first sign of multiple sclerosis.

2. Infectious myelopathy: herpes zoster with previous radicular symptoms and rash, most often viral nature; also occurs with infection with a lymphotropic retrovirus, HIV, with poliomyelitis.

Vascular myelopathy. Spinal cord infarction, anomalies in the development of blood vessels.

Chronic myelopathy. Spondylosis, degenerative and hereditary myelopathy, subacute combined degeneration (deficiency of vitamin B 12), syringomyelia, dorsal tabes.

Instrumental Research

Plain radiography, CT scan of the spine to detect fractures and curvature of the spinal column, as well as to identify possible metastases to the spine. MRI serves as a high-resolution, accelerated evaluation method, especially for the diagnosis of intramedullary lesions, and is preferred over conventional myelography. Analysis of CSF for the presence of an infectious process, multiple sclerosis, carcinoma. Somatosensory evoked responses may be pathological.

Treatment:

Compression caused by a tumor: With epidural metastases large doses glucocorticoids (to reduce edema) and local irradiation of metastases, with or without chemotherapy; surgical intervention is used if the tumor is insensitive to radiation therapy or does not respond maximum doses irradiation. Surgical removal tumor is indicated for neurofibromas, meningiomas or other extramedullary tumors.

epidural abscess: Usually requires emergency surgery to drain the abscess and bacteriological research followed by a course of intravenous antibiotics.

Epidural hemorrhage, or hematomyelia: If access is available, the clot is urgently removed. The causes of dyscrasia leading to hemorrhage should be established and, if possible, eliminated or corrected. Diagnosis of arteriovenous developmental anomalies can be performed using MRI, myelography, or arteriography of segmental spinal arteries.

Acute protrusion of the disc, spinal fracture or displacement: Requires surgical intervention.

Complications: Damage urinary tract associated with urinary retention due to bladder distension, and damage to the detrusor muscle of the bladder; paroxysmal hypertension or hypotension with volume disturbances; ileus and gastritis; with high cervical injuries of the spinal cord - mechanical respiratory failure; severe hypertension and bradycardia in response to irritation or distension of the bladder and intestines; urinary tract infections; bedsores; TELA.

The reasons emergency conditions with spinal lesions, they can be traumatic or non-traumatic.

To non-traumatic reasons include:

• Medullary processes:
  • spinal cord inflammation: myelitis, viral and autoimmune
  • medullary tumors (gliomas, ependymomas, sarcomas, lipomas, lymphomas, drip metastases); paraneoplastic myelopathy (eg, in bronchial carcinoma and Hodgkin's disease)
  • radiation myelopathy in the form of acute, from incomplete to complete, symptoms of lesions at a certain level of the spinal cord at radiation doses of 20 Gy with a latency of several weeks to months and years
  • vascular spinal syndromes: spinal ischemia (eg, after aortic surgery or aortic dissection), vasculitis, embolism (eg, decompression sickness), vascular compression (eg, due to mass effect), and spinal arteriovenous malformations, angiomas, cavernomas, or dural fistulas ( With venous congestion and congestive ischemia or hemorrhage)
  • metabolic myelopathy (with acute and subacute course); funicular myelosis with vitamin B 12 deficiency; hepatic myelopathy in liver failure
• Extramedullary processes:
  • purulent (bacterial) spondylodiscitis, tuberculous spondylitis (Pott's disease), mycotic spondylitis, epi- or subdural abscess;
  • chronic inflammatory rheumatic diseases of the spine, such as rheumatoid arthritis, seronegative spondyloarthropathy (ankylosing spondylitis), psoriatic arthropathy, enteropathic arthropathy, reactive spondyloarthropathy, Reiter's disease;
  • extramedullary tumors (neurinomas, meningiomas, angiomas, sarcomas) and metastases (eg, bronchial cancer, multiple myeloma [plasmocytoma]);
  • spinal subdural and epidural hemorrhages in blood clotting disorders (anticoagulation!), condition after injury, lumbar puncture, epidural catheter and vascular malformations;
  • degenerative diseases such as osteoporotic fractures of the spine, spinal canal stenosis, herniated discs.

To traumatic reasons include:

• Contusion, infringement of the spinal cord
• Traumatic hemorrhages
• Fracture/dislocation of the vertebral body

Non-traumatic spinal cord injuries

Inflammation/infection of the spinal cord

Common causes acute myelitis are, first of all, multiple sclerosis and viral inflammations; however, pathogens are not detected in more than 50% of cases.

Risk factors for spinal infection are:

• Immunosuppression (HIV, immunosuppressive drug therapy)
• Diabetes
• Alcohol and drug abuse
• Injuries
• Chronic diseases of the liver and kidneys.

Against the background of a systemic infection (sepsis, endocarditis), especially in these risk groups, additional spinal manifestations of infection may also be noted.

spinal ischemia

Spinal ischemia, compared with cerebral ischemia, is rare. In this regard, a favorable effect is exerted, first of all, by good collateralization of the blood flow of the spinal cord.

The following are considered as causes of spinal ischemia:

• Arteriosclerosis
• aortic aneurysm
• Operations on the aorta
• Arterial hypotension
• Obstruction/dissection of the vertebral artery
• Vasculitis
• Collagenosis
• Embolic vascular occlusion (eg, decompression sickness in divers)
• Spinal volumetric processes (intervertebral discs, tumor, abscess) with vascular compression.

In addition, there are also idiopathic spinal ischemias.

Tumors of the spinal cord

According to anatomical localization spinal tumors/volume processes are subdivided into:

• Vertebral or extradural tumors (eg, metastases, lymphomas, multiple myeloma, schwannomas)
• Tumors of the spinal cord (spinal astrocytoma, ependymoma, intradural metastases, hydromyelia/syringomyelia, spinal arachnoid cysts).

Hemorrhage and vascular malformations

Depending on the compartments, there are:

• epidural hematoma
• subdural hematoma
• Spinal subarachnoid hemorrhage
• Hematomyelia.

Spinal hemorrhages are rare.

The reasons are:

• Diagnostic/therapeutic measures such as lumbar puncture or epidural catheter
• Oral anticoagulation
• Blood clotting disorders
• Malformations of the spinal vessels
• Injuries
• Tumors
• Vasculitis
• Manual therapy
• Rarely, aneurysms in the cervical region (vertebral artery)

Vascular malformations include:

• Dural arteriovenous fistulas
• Arteriovenous malformations
• Cavernous malformations and
• spinal angiomas.

Symptoms and signs of non-traumatic spinal cord injury

The clinical picture in spinal emergencies depends mainly on the underlying etiopathogenesis and localization of the lesion. These conditions typically present with acute or subacute neurological deficits, which include:

• Sensitization disorders (hypesthesia, par- and dysesthesia, hyperpathia) usually caudal to spinal cord injury
• Motor deficits
• Vegetative disorders.

The phenomena of prolapse may be lateralized, but they also manifest themselves in the form of acute symptoms of a transverse spinal cord lesion.

ascending myelitis can lead to damage to the brainstem with cranial nerve prolapse and dative insufficiency, which may clinically correspond to the pattern of Landry's palsy (= ascending flaccid paralysis).

Back pain, often drawing, stabbing or blunt, felt primarily in extramedullary inflammatory processes.

With local inflammation fever may initially be absent and develops only after hematogenous dissemination.

spinal tumors initially often accompanied by back pain, which is aggravated by percussion of the spine or during exercise, neurological deficits do not have to be present. Radicular pain can occur with damage to the nerve roots.

Symptoms spinal ischemia develops over a period of minutes to hours and, as a rule, covers the pool of the vessel:

• Syndrome of the anterior spinal artery: often radicular or girdle pain, flaccid tetra- or paraparesis, lack of pain and temperature sensitivity while maintaining vibration sensitivity and joint-muscular feeling
• Sulco-commissural artery syndrome
• back syndrome spinal artery: loss of proprioception with ataxia when standing and walking, sometimes paresis, dysfunction of the bladder.

Spinal hemorrhages are characterized by acute - often unilateral or radicular - back pain, usually with incomplete symptomatology of the transverse spinal cord lesion.

Due to malformations of the spinal vessels often slowly progressing symptoms of transverse lesions of the spinal cord develop, sometimes fluctuating or paroxysmal.

At metabolic disorders it is necessary, first of all, to remember the deficiency of vitamin B12 with a picture of funicular myelosis. It often presents in patients with pernicious anemia (eg, Crohn's disease, celiac disease, malnutrition, a strict vegetarian diet) and slowly progressive motor deficits, such as spastic paraparesis and gait disturbances, and sensory deficits (paresthesias, decreased vibration sensitivity). ). Additionally, cognitive functions usually worsen (confused consciousness, psychomotor retardation, depression, psychotic behavior). Rarely, with impaired liver function (mainly in patients with a portosystemic shunt), hepatic myelopathy develops with damage to the pyramidal tract.

Polio classically proceeds in several stages and begins with a fever, followed by a meningitis stage until the development of a paralytic stage.

spinal syphilis with tabes of the spinal cord (myelitis of the posterior / lateral funiculus of the spinal cord) as late stage neurosyphilis is accompanied by progressive paralysis, sensory disturbances, stabbing or cutting pains, loss of reflexes and dysfunction of the bladder.

Myelitis at tick-borne encephalitis often associated with "severe transverse symptomatology" involving the upper extremities, cranial nerves, and diaphragm, and has a poor prognosis.

Optic neuromyelitis(Devic's syndrome) is autoimmune disease that predominantly affects young women. It is characterized by signs of acute (transverse) myelitis and optic neuritis.

Radiation myelopathy develops after irradiation, as a rule, with a latency of several weeks to months and may present with acute spinal symptoms (paresis, sensory disturbances). The diagnosis is indicated by the history, including the size of the radiation field.

Diagnosis of non-traumatic spinal cord injuries

Clinical examination

Localization of damage is established by the study of sensitive dermatomes, myotomes and stretch reflexes of skeletal muscles. The study of vibration sensitivity, including the spinous processes, helps in determining the level of localization.

Autonomic disorders can be identified, for example, through the tone of the anal sphincter and impaired bladder emptying with the formation of residual urine or incontinence. Limited inflammation of the spine and adjacent structures is often accompanied by pain on tapping and squeezing.

Symptoms of spinal inflammation at first can be completely non-specific, which significantly complicates and slows down the diagnosis.

Difficulties arise in the differentiation caused by the pathogen and parainfectious myelitis. In the latter case, an asymptomatic interval between a previous infection and myelitis is often described.

Visualization

If a spinal process is suspected, the method of choice is MRI in at least two projections (sagittal + 33 axial).

spinal ischemia, inflammatory foci, metabolic changes and tumors especially well visualized on T2-weighted images. Inflammatory or edematous changes, as well as tumors, are well displayed in STIR sequences. After the injection of a contrast agent in T1 sequences, blooming inflammatory foci and tumors are usually well differentiated (sometimes subtractions of the original T1 from T1 after the injection of a contrast agent for more accurate delimitation of the contrast). If bone involvement is suspected, T2 or STIR sequences with fat saturation, or T1 after contrast agent injection, are appropriate for better differentiation.

Spinal hemorrhages can be recognized on CT in case of emergency diagnosis. However, MRI is the method of choice for better anatomical and etiological classification. Hemorrhages on MRI are displayed differently, depending on their stage (< 24 часов, 1-3 дня и >3 days). If there are contraindications to MRI, then to assess bone damage and clarify the issue of significant mass effects in extramedullary inflammatory processes, CT of the spine with contrast is performed.

To minimize the radiation dose received by the patient, it is advisable to determine the level of damage based on clinical picture.

AT rare cases(functional imaging, intradural volumetric processes with bone lesions), it is advisable to perform myelography with postmyelographic computed tomography.

Degenerative changes, fractures and osteolysis of the vertebral bodies can often be recognized on a plain x-ray.

Liquor research

An important role is played by cytological, chemical, bacteriological and immunological analysis of CSF.

Bacterial inflammation usually accompanied by a marked increase in the number of cells (> 1000 cells) and total protein. If a bacterial infection is suspected, it is necessary to strive to isolate the pathogen by sowing the cerebrospinal fluid on the flora or PCR method. With signs of systemic inflammation, the bacterial pathogen is detected by blood culture.

At viral inflammations, apart from a slight or moderate increase in the number (usually from 500 to a maximum of 1000 cells), there is usually only a slight increase in the level of proteins. On the viral infection may indicate the detection of specific antibodies (IgG and IgM) in the cerebrospinal fluid. The formation of antibodies in the CSF can be reliably confirmed by determining the avidity index of specific antibodies (AI). An index >1.5 is suspicious, and values ​​>2 indicate the formation of antibodies in the central nervous system.
Antigen detection by PCR is a fast and reliable method. This method can, in particular, provide important information in the early phase of infection, when the humoral immune response is still insufficient. In autoimmune inflammation, there is a slight pleocytosis (< 100 клеток), а также нарушения гематоэнцефалического барьера и повышение уровня белков

In multiple sclerosis, more than 80% of patients have oligoclonal bands in the CSF. Optical neuromyelitis in more than 70% of patients is associated with the presence in the serum of specific antibodies to aquaporin 4.

Other diagnostic measures

Routine laboratory diagnostics, general analysis blood and C-reactive protein in the case of isolated inflammatory spinal processes do not always help, and often in the initial phase, no anomalies are found in the analyzes, or only minor changes are present. However, an increase in C-reactive protein levels in bacterial spinal inflammation is non-specific sign, which should entail a detailed diagnosis.

Pathogens are identified by bacterial blood culture, sometimes by biopsy (CT-guided puncture for abscess or discitis) or intraoperative sampling.

Electrophysiological studies serve to diagnose functional damage nervous system and, above all, to assess the forecast.

Differential Diagnosis

Attention: such a phenomenon in the cerebrospinal fluid can occur with "cerebrospinal fluid blockade" (in the absence of cerebrospinal fluid flow as a result of mechanical displacement of the spinal canal).

Differential diagnosis of non-traumatic spinal injuries includes:

• Acute polyradiculitis (Guillain-Barré syndrome): acute "ascending" sensorimotor deficits; it is usually possible to differentiate myelitis on the basis of a typical cell-protein dissociation in the cerebrospinal fluid with an increase in total protein while maintaining normal amount cells.
• Hyper- or hypokalemic paralysis;
• Syndromes with polyneuropathy: chronic inflammatory demyelinating polyneuropathy with acute deterioration, borreliosis, HIV infection, CMV infection;
• Myopathic syndromes (myasthenia gravis, dyskalemic paralysis, rhabdomyolysis, myositis, hypothyroidism): usually an increase in creatine kinase, and in dynamics - a typical EMG picture;
• Parasagittal cortical syndrome (eg, sickle brain tumor);
• Psychogenic symptoms of transverse lesions of the spinal cord.

Complications of emergencies in spinal lesions

• Prolonged sensorimotor deficits (paraparesis/paraplegia) with increased risk
  • deep vein thrombosis (thrombosis prevention)
  • contractures
  • spasticity
  • bedsores
• With high cervical injuries, the risk of respiratory disorders - increased risk of pneumonia, atelectasis
• Autonomic dysreflexia
• Impaired bladder function, increased risk of urinary tract infections up to urosepsis
• Impaired bowel function -» danger of excessive bloating, paralytic ileus
• Temperature regulation disorders in the case of lesions located at the level of 9-10 thoracic vertebrae with the risk of hyperthermia
• Increased risk of orthostatic hypotension

Treatment of non-traumatic spinal cord injuries

Inflammation of the spinal cord

Except specific therapy directed against the pathogen, general measures must first be carried out, such as installation urinary catheter with violations of bladder emptying, prevention of thrombosis, changing the position of the patient, timely mobilization, physiotherapy and pain therapy.

General therapy: drug therapy depends mainly on the etiopathogenesis of the spinal lesion or on the pathogen. Often in the initial phase it is not possible to unambiguously establish the etiological affiliation or isolate pathogens, so the choice of drugs is carried out empirically, depending on clinical course, the results of laboratory diagnostics and the study of cerebrospinal fluid, as well as the expected spectrum of pathogens.

In the beginning, a broad combination antibiotic therapy should be carried out using an antibiotic that acts on the central nervous system.

In principle, antibiotics or virostatic agents should be used in a targeted manner.

The choice of drugs depends on the results of the study. bacteriological cultures blood and cerebrospinal fluid or cerebrospinal fluid punctures (an angiogram is required!), as well as from the results of serological or immunological studies. In the case of a subacute or chronic course of the disease, if the clinical situation allows it, a targeted diagnosis should first be carried out, if possible with isolation of the pathogen, and, if necessary, a differential diagnosis.

In case of bacterial abscesses, in addition to antibiotic therapy (if it is possible from an anatomical and functional point of view), the possibility should be discussed and an individual decision should be made on neurosurgical debridement of the focus.

Specific therapy:

• idiopathic acute transverse myelitis. There are no placebo-controlled randomized trials that unequivocally support the use of cortisone therapy. By analogy with the treatment of other inflammatory diseases and based on clinical experience, 3-5 days of intravenous cortisone therapy with methylprednisolone at a dose of 500-1000 mg is often performed. Patients with a severe clinical condition may also benefit from more aggressive cyclophosphamide therapy and plasmapheresis.
• myelitis associated with herpes simplex and herpes zoster: acyclovir.
• CMV infections: ganciclovir. In rare cases of intolerance to acyclovir in HSV, varicella-zoster or CMV infections, foscarnet can also be used.
• neuroborreliosis: 2-3 weeks antibiosis with ceftriaxone (1x2 g/day IV) or cefotaxime (3x2 g/day IV).
• neurosyphilis: penicillin G or ceftriaxone 2-4 g/day intravenously (the duration of therapy depends on the stage of the disease).
• tuberculosis: multi-month four-component combination therapy with rifampicin, isoniazid, ethambutol and pyrazinamide.
• spinal abscesses with progressive neurological prolapse (eg, myelopathic signal on MRI) or pronounced signs of a volumetric process require urgent surgical intervention.
• spondylitis and spondylodiscitis are often treated conservatively with immobilization and (if possible targeted) antibiotic therapy for at least 2-4 weeks. Antibiotics that act well on the CNS for Gram-positive pathogens include, for example, fosfomycin, ceftriaxone, cefotaxime, meropenem and linezolid. In the case of tuberculous osteomyelitis, multi-month anti-tuberculosis combination therapy is indicated. In the absence of effect or severe symptoms, before
  In general, bone destruction with signs of instability and/or depression of the spinal cord may require surgical debridement with removal of the intervertebral disc and subsequent stabilization. Surgical measures should be discussed primarily in the case of compression of neural structures.
• - neurosarcoidosis, neuro-Behcet, lupus erythematosus: immunosuppressive therapy; depending on the severity of the disease, cortisone is used and, mainly in long-term therapy, also methotrexate, azathioprine, cyclosporine and cyclophosphamide.

spinal ischemia

Therapeutic options for spinal ischemia are limited. Recommendations evidence-based medicine missing. The restoration or improvement of the spinal circulation comes to the fore in order to prevent further damage. Accordingly, it is necessary, as far as possible, to therapeutically address the underlying causes of spinal ischemia.

In case of vascular occlusion, blood coagulation (anticoagulation, heparinization) should be taken into account. Administration of cortisone is not recommended due to potential side effects.

In the initial phase, the basis of therapy is the control and stabilization of vital functions, as well as the prevention of complications (infections, bedsores, contractures, etc.). In the future, neurorehabilitation measures are shown.

Tumors

In the case of isolated volumetric processes with compression of the spinal cord, urgent surgical decompression is necessary. The longer there is or continues spinal cord injury (>24 hours), the worse the chances of recovery. In the case of radiosensitive tumors or metastases, the possibility of irradiation is considered.

Other therapeutic options, depending on the type of tumor, its prevalence and clinical symptoms, include conservative therapy, radiation (including gamma knife), chemotherapy, thermocoagulation, embolization, vertebroplasty, and with signs of instability, various stabilization measures. Therapeutic approaches should be discussed interdisciplinary, with neurologists, neurosurgeons/trauma surgeons/orthopedics oncologists (radiotherapy specialists).

For spinal volume processes with edema, cortisone is used (eg 100 mg hydrocortisone per day, according to the standards of the German Society of Neurology 2008, alternatively dexamethasone, eg 3 x 4-8 mg/day). The duration of treatment depends on the clinical course and/or changes in imaging data.

Spinal hemorrhages

Depending on the clinical course and volumetric nature of the process, sub- or epidural spinal hemorrhage may require surgical intervention (often decompressive laminectomy with blood aspiration).

With small hemorrhages without signs of a mass effect and with minor symptoms, conservative expectant management with control of the dynamics of the process is initially justified.

Spinal vascular malformations respond well to endovascular therapy (embolization). First of all, type I arteriovenous malformations (=fistulas) can often be occluded. Other arteriovenous malformations may not always be occluded, but can often be reduced in size.

Prognosis for non-traumatic spinal cord injuries

K prognostic unfavorable factors Inflammatory injuries of the spinal cord include:

• Initially rapidly progressive course
• Duration of neurological loss for more than three months
• Detection of protein 14-3-3 in CSF as a sign of neuronal damage
• Pathological motor and sensory evoked potentials, as well as signs of denervation on EMG.

Approximately 30-50% of patients with acute transverse myelitis have a poor outcome with residual severe disability, and the prognosis for multiple sclerosis is better than for patients with other causes of transverse spinal cord syndrome.

The prognosis of spondylitis/spondylodiscitis and spinal abscesses depends on the size and duration of damage to neural structures. The decisive factor is therefore timely diagnosis and therapy.

The prognosis of spinal ischemia, due to limited therapeutic options, is poor. Most patients have a persistent neurological deficit, depending mainly on the type of primary lesion.

The prognosis for spinal volumetric processes depends on the type of tumor, its prevalence, the scale and duration of damage to neural structures, and the possibilities or effect of therapy.

The prognosis of spinal hemorrhages is determined mainly by the severity and duration of neurological deficits. With small hemorrhages and conservative tactics, the prognosis in most cases can be favorable.

Traumatic spinal cord injury

Spinal injuries occur as a result of high-energy force impact. Common reasons include:

• high speed crash
• Fall from high altitude and
• Direct force.

Depending on the accident mechanism, axial forces can lead to compression fractures of one or more vertebrae, as well as to flexion-extension injuries of the spine with distraction and rotational components.

Approximately 15-20% of patients with severe traumatic brain injury have concomitant injuries of the cervical spine. Approximately 15-30% of patients with polytrauma have spinal injuries. Fundamentally recognized is the allocation in the spine of the anterior, middle and posterior columns or column ( three-column model Denis), and the anterior and middle columns of the spine include the vertebral bodies, and the posterior - their dorsal segments.

A detailed description of the type of injury reflecting functional and prognostic criteria is classification of injuries of the thoracic and lumbar spine, according to which spinal injuries are divided into three main types A, B and C, where each of the categories includes three further subtypes and three subgroups. Instability increases in the direction from type A to type C and within the respective subgroups (from 1st to 3rd).

For injuries of the upper cervical spine, due to anatomical and biomechanical features, there is separate classification.

In addition to fractures, the following injuries occur with spinal injuries:

• Hemorrhages in the spinal cord
• Bruises and swelling of the spinal cord
• Spinal cord ischemia (due to compression or rupture of arteries)
• Ruptures, as well as displacement of the intervertebral discs.

Symptoms and signs of traumatic spinal cord injury

In addition to the anamnesis (primarily the mechanism of the accident), a decisive role for further diagnostic and therapeutic measures play the clinical picture. The following are the main clinical aspects of traumatic spinal injuries:

• Pain in the area of ​​the fracture during tapping, compression, movement
• Stable fractures are usually painless; unstable fractures often cause more severe pain with limited movement
• Hematoma at the fracture site
• Spinal deformity (such as hyperkyphosis)
• Neurological prolapse: radicular pain and / or sensory disturbances, symptoms of incomplete or complete transverse spinal cord injury, dysfunction of the bladder and rectum in men, sometimes priapism.
• Respiratory failure with high cervical paralysis (C 3-5 innervate the diaphragm).
• Prolapse of the brainstem/cranial nerves in atlanto-occipital dislocations.
• Rarely traumatic injuries of the vertebral or basilar arteries.
• Spinal shock: transient loss of function at the level of spinal cord injury with loss of reflexes, loss of sensorimotor functions.
• Neurogenic shock: develops mainly with injuries of the cervical and thoracic spine in the form of a triad: hypotension, bradycardia and hypothermia.
• Autonomic dysreflexia in case of lesions within T6; as a result of the action of various nociceptive stimuli (for example, tactile stimulation), an excessive sympathetic reaction with vasoconstriction and elevation may develop below the level of the focus systolic pressure up to 300 mm Hg, as well as a decrease in peripheral circulation (pallor skin). Above the level of the focus in the spinal cord, compensatory vasodilation develops (skin redness and sweating). In view of blood pressure crises and vasoconstriction - with the risk of cerebral hemorrhage, cerebral and myocardial infarction, arrhythmias up to cardiac arrest - autonomic dysreflexia is a serious complication.
• Brown-Séquard Syndrome: Usually a semi-spinal cord lesion with ipsilateral paralysis and loss of proprioception, as well as contralateral loss of pain and temperature sensations.
• Medullary cone syndrome: damage to the sacral spinal cord and nerve roots of the lumbar region with areflexia of the bladder, intestines and lower extremities with sometimes remaining reflexes at the sacral level (for example, the bulbocavernosal reflex).
• Cauda equina syndrome: damage to the lumbosacral nerve roots with areflexia of the bladder, intestines and lower extremities.

Diagnosis of traumatic spinal cord injuries

The classification developed by the American Spinal Injury Association can be used to determine the level and severity of spinal cord injury.

Every patient with neurological deficits due to trauma needs adequate and timely primary diagnostic imaging. In patients with moderate to severe traumatic brain injury, it is necessary to examine the cervical spine with top thoracic region included.

For mild to moderate injuries (without neurological deficits), the following signs indicate the need for timely imaging:

• Changing state of consciousness
• Intoxication
• Pain in the spine
• Distraction damage.

An important role in the decision to conduct imaging play elderly age patient and significant past or concomitant diseases, as well as the mechanism of the accident.

Patients with a minor mechanism of injury and a low risk of damage often do not need hardware diagnostics, or only plain radiography (if indicated, additional functional radiography) is sufficient. As soon as the likelihood of spinal injury is identified based on risk factors and the course of injury, due to higher sensitivity, CT of the spine should be performed initially.

When possible damage vessels additionally requires CT angiography.

MRI is inferior to CT in the emergency diagnosis of spinal injury, since it allows only a limited assessment of the extent of bone damage. However, in case of neurological deficits and ambiguous CT results, MRI should be additionally performed in case of emergency diagnosis.

MRI is shown mainly in the sub-acute phase and to monitor the dynamics of neural damage. In addition, the ligamentous and muscular components of the injury can be better assessed, as well as, if necessary, lesions in these components.

Visualization should answer the following questions:

• Is there any trauma at all?
• If yes, what type (fracture, dislocation, hemorrhage, brain compression, ligament lesions)?
• Is there an unstable situation?
• Is surgery required?
• Daffner recommends assessing spinal injury as follows:
• Alignment and anatomical abnormalities: anterior and posterior margin of the vertebral bodies in the sagittal plane, spinolaminar line, lateral masses, inter-articular and interspinous distance;
• Bone - violation of the integrity of the bone: rupture of the bone / fracture line, compression of the vertebral bodies, "bone nodules", displaced bone fragments;
• Cartilage-anomalies of the cartilage / joint cavity: an increase in the distances between the small vertebral joints (> 2 mm), inter-articular and interspinous distances, expansion of the intervertebral space;
• Soft tissue - anomalies soft tissue: hemorrhages with spread to the retrotracheal (< 22 мм) и ретрофарингеальное пространство (>7 mm), paravertebral hematomas.

In case of severe injuries of the spine, a search for other injuries (skull, chest, abdomen, blood vessels, limbs) should always be carried out.

Laboratory diagnostics includes a hemogram, coagulogram, determination of the level of electrolytes and functional indicators of the kidneys.

For neurological disorders in subacute phase needs to be additional electrophysiological diagnostics to assess the extent of functional damage.

Complications of injuries of the spine and spinal cord

• Spinal instability with secondary spinal cord injuries
• Spinal cord injury (myelopathy) due to compression, contusion with various types of prolapse:
• - complete transverse paralysis (depending on the level of tetra- or paraplegia and corresponding sensory deficits)
• incomplete transverse paralysis (paraparesis, tetraparesis, sensory deficits)
• With a high cervical transverse lesion - respiratory failure
• Cardiovascular Complications:
• orthostatic hypotension(most pronounced in the initial phase, improvement in dynamics)
• loss/weakening of diurnal fluctuations in blood pressure
• violations heart rate(in the case of lesions above T6, predominantly bradycardia as a result of loss of sympathetic innervation and dominance of vagus nerve stimulation)
• Deep vein thrombosis and pulmonary embolism
• Long-term complications of transverse paralysis:
• areflexia (diagnosis = combination of arterial hypertension and vasoconstriction below the level of damage)
• post-traumatic syringomyelia: symptoms are often months or years later with neurological pain above the level of the focus, as well as an increase in neurological deficits and spasticity, deterioration in the functions of the bladder and rectum (diagnosis is established using MRI)
• heterotopic ossification = neurogenic paraarticular ossification below the level of the lesion
• spasticity
• painful contractures
• bedsores
• chronic pain
• urinary disorders with an increased percentage of urinary tract/kidney infections
• increased risk of infections (pneumonia, sepsis)
• intestinal motility and bowel movements
• psychological and psychiatric problems: stress disorder, depression

Treatment of traumatic spinal cord injuries

Depending on the scale of neurological damage and the immobility associated with them, great importance is attached to conservative, preventive and rehabilitation measures:

• Intensive medical monitoring, especially in the initial phase, to maintain normal cardiovascular and pulmonary functions;
• With arterial hypotension, an attempt at therapy by adequate fluid replacement; in the initial phase, according to indications, the appointment of vasopressors;
• Prevention of bedsores, thrombosis and pneumonia;
• Depending on the stability and course of the disease, early mobilization and physiotherapy measures.

Attention: autonomic disorders (orthostatic hypotension, autonomic dysreflexia) significantly complicate mobilization.

The indication for surgical intervention (decompression, stabilization) depends primarily on the type of injury. In addition to eliminating possible myelocompression, surgical intervention is necessary in unstable situations (injuries of types B and C).

Surgery requires the appropriate competence of neurosurgeons, trauma surgeons and orthopedists.

In severe traumatic compression of the spinal cord with neurological symptoms, urgent surgical decompression is indicated (within the first 8-12 hours). In the absence of neurological prolapse or in case of inoperability, depending on the type of injury, the possibility of conservative (non-invasive) treatment tactics is considered individually, for example, using a head HALO fixator for injuries of the cervical spine.

The use of methylprednisolone in spinal cord injury remains controversial. Despite scientific indications of an effect in the case of early start, critics focus primarily on side effects (eg, increased incidence of pneumonia and sepsis) and possible collateral damage (eg, traumatic brain injury, CRASH study). In case of spinal cord edema (or expected edema), methylprednisolone (eg Urbason) may be given. As a bolus, 30 mg/kg of body weight is administered intravenously followed by a long-term infusion. If the introduction is carried out within the first three hours after injury, a long-term infusion is carried out within 24 hours, if started between 3 and 8 hours after injury - within 48 hours.

The therapy of autonomic dysreflexia consists, first of all, in the elimination of the provoking stimulus. For example, a clogged urinary catheter that caused a distension of the bladder, inflammation of the skin, distension of the rectum. With persistent, despite the elimination of provoking stimuli, arterial hypertension, medications to reduce pressure, such as nifedipine, nitrates or captopril.

Prognosis for traumatic spinal cord injuries

The prognosis depends mainly on the location of the injury, its severity and type (polysegmental or monosegmental), as well as on the primary neurological status. In addition to the clinical picture, MRI is necessary to elucidate morphological lesions, and additional electrophysiological diagnostics (evoked sensory and motor potentials, EMG) are required to identify functional foci. Depending on the primary damage, there may be a complete loss of function, a partial loss of motor and sensory functions, but also their full recovery. The prognosis for severe intramedullary hemorrhage, edema, and spinal cord compression is poor.

Specialists distinguish combined, ischemic (myeloishemia) and hemorrhagic vascular diseases of the spinal cord. Also, these diseases include a variety of malformations. vascular system in the spinal cord, such as vascular malformations and aneurysms.

Signs of vascular diseases of the spinal cord

Vascular diseases of the spinal cord can develop according to the most different reasons- due to acquired changes vascular wall, congenital vascular anomalies.

Types of Violations

Acute violation of spinal circulation can manifest itself in a very diverse way, so only a qualified doctor can recognize it after using various diagnostic methods. In some cases, the causes of the symptoms of these diseases may be congenital anomalies the structure of the vessels of the capillary, venous or arterial bed - they may not appear for many years, and the reasons for their progression are different.

The manifestations of spinal cord infarction are varied, since they directly depend on where the lesion is localized. So, if there is a blockage of the anterior spinal cord, then necrosis will occur in the anterior part of the spinal cord. In this case, the patient will subacutely or acutely develop lower spastic paraplegia, accompanied by a violation of the functions of the pelvic organs and a violation of sensitivity. If the anterior spinal artery, located at the level of the cervical segments, is affected, flaccid hands and spastic paraparesis of the legs will appear, accompanied by dissociated temperature and pain paraanesthesia (that is, loss of sensation in symmetrical parts of the body) and dysfunction of the pelvic organs. In the event that the lesion occurred in the region of the lumbosacral segments, a lower flaccid paraplegia will appear, accompanied by areflexia, dissociated paraanesthesia and disruption of the pelvic organs.

In any case, to clarify the cause of the pathology and the mechanism of its development, it is necessary to consult a qualified specialist (neurologist or neuropathologist), as well as the implementation of a whole complex diagnostic procedures and laboratory analyses.

Manifestations of pathology and their dependence on the types of disorders

If any diseases of the spinal cord have arisen, the symptoms are likely to appear almost immediately. For such diseases, first of all, loss of sensitivity in the area located below the so-called "level of sensitivity disorders", which is accompanied by spasticity of the limbs and muscle weakness, is characteristic.

Sensitivity disorders most often manifest as paresthesias that develop in both feet or in one of them. In this case, paresthesia can spread upward. The level of disturbance of vibration and pain sensitivity, as a rule, coincides with the level of localization of the transverse lesion of the spinal cord.

Various autonomic dysfunctions are also characteristic of this kind of disease. First of all, the patient should be alerted by acute or progressive urinary retention, which is accompanied by spasticity and sensitivity disorder.

If there is a rupture of the corticospinal tracts, then the patient will develop quadriplegia or paraplegia, accompanied by increased muscle tone, increased tendon reflexes, as well as a positive Babinsky symptom. There are also segmental signs of the disease, which serve as an indicative indicator of the level of damage.

One of the leading symptoms of this kind of disease is pain. , which are localized along the midline, help doctors determine the place where the lesion is localized. may signal compression of the spinal cord radiating to the lower back, then this symptom may indicate damage to the medullary cone, that is, the terminal part of the spinal cord.

If a lesion occurs at the level of the L4 vertebra or below it, then the patient will have an asymmetric flaccid paraparesis, accompanied by dysfunction of the rectum and bladder, lack of reflexes, loss of sensitivity (starting from level L). As a rule, patients complain of pain that radiates to the thigh and perineum. When the medullary cone is affected, pain is not observed, but dysfunction of the rectum and bladder quickly appears. If a person has simultaneous compression injuries of the cauda equina and cone, then he will have signs of peripheral motor neurons, hyperreflexia, or a positive Babinsky symptom.

Extramedullary disorders

Extramedullary lesions are characterized by signs such as symptoms of asymmetric lower motor neuron lesions, Brown-Séquard syndrome, sacral loss of sensation, and early corticospinal symptoms. If the lesion is localized at the level of Foramen magnum, then the person will be disturbed by muscle weakness of the arm and shoulder, which is accompanied by ipsilateral, and then contralateral lesion of the leg, and later the arm. If present, the doctor may assume that the cervical region is affected.

intramedullary disorders

But intramedullary lesions are usually accompanied by very burning pain. Moreover, it is quite difficult to determine the localization of unpleasant sensations. Also, the patient has a loss of pain sensitivity (while the sense of the position of the joint, sacral and perineal sensations are preserved) and mild corticospinal symptoms.

Signs of vascular diseases of the spinal cord in children

The clinic of the disease depends on how common the vascular pathology is along the diameter and length of the spinal cord, as well as on the level at which the lesion is localized.

Ischemia in the cervical region in children will be manifested by weakness of both or only one of the hands, as well as a decrease in their muscle tone. If the child suddenly has weakness in both legs, then this may be a signal of a violation of blood supply at the lumbar or thoracic level of the spinal cord. Sometimes weakness in the legs is accompanied by dysfunction of the pelvic organs, in particular, a violation of urination. Thus, it can be assumed that enuresis in some children may have a vascular origin.

Sometimes a feeling of weakness in the legs is observed in children only while walking. At the same time, stops or rest significantly improve the well-being of the baby. This symptom is called "intermittent spinal claudication".

Arteriovenous malformation is characterized by slow progression. The child gradually increases the feeling of weakness in the region of both legs, he is concerned about pain in the spine, radiating to the legs, and sometimes disturbances of the type of "intermittent claudication".

In order to diagnose a child with a disease of this kind, it is necessary to contact qualified specialist. He will be able to determine which diagnostic procedures the child needs to undergo in order to make an accurate diagnosis. It could be CT scan, analysis of cerebrospinal fluid and other methods of examination.

In patients, even early age it cannot be ruled out that malignant neoplasms can be hidden under the symptoms of vascular pathology. A timely examination will help to distinguish them - the tactics of treatment and the prognosis of these conditions are different, but in both cases, timely therapy is necessary.

Treatment of vascular diseases of the spinal cord

Treatment of this kind of disease can only be carried out by a qualified doctor.. Attempts to self-medicate or the appointment of medication and other types of therapy before the diagnosis (at least preliminary) can be provoked by a sharp deterioration in the patient's well-being. If acute or rapidly progressive circulatory disorders in the vessels of the spinal cord are detected, it is possible simultaneous holding diagnostic procedures, tests and prescribing drugs that improve the patient's condition, regardless of age.

What are the components of the treatment?

Drug treatment of this pathology involves the use of almost all groups pharmacological preparations known to modern medicine. Medicines prescribed by a doctor can be prescribed both in the form of injections (mainly intramuscular or intravenous) and in the form of tablets (when the activity of the process subsides).

In any case, the therapy program should take into account:

• the use of drugs that improve microcirculation and collateral circulation, such as complamin, eufillin, cavinton, a nicotinic acid and dibazol;
• diuretic prescription medicines eg lasix;
• the use of antiplatelet agents (for example, acetylsalicylic acid);
• prescribing vitamins B and C.

Features of the therapy of some vascular pathologies of the SM

During the recovery period, various physiotherapy procedures can be prescribed, and. Often, the treatment uses drugs that can stimulate the conduction of nerve impulses (galantamine, prozerin, and others), as well as absorbable agents (cerebrolysin, aloe, and so on). Doctors often use medications that reduce muscle tone(relanium, elenium, phenibut and others).

In the event that compression was caused by a tumor and the patient has epidural metastases, he is prescribed to reduce swelling, and radiation of metastases is also performed, but chemotherapy is not always used. If the tumor does not respond to such treatment, surgery is performed.

Surgical treatment is also required for spinal fracture or displacement (spinal injuries) - these pathologies are not vascular disorders, but circulatory disorders remain one of the essential components of this condition.

With epidural, regardless of the cause of its development, an urgent surgical intervention is performed to drain it, as well as to obtain purulent material for bacteriological examination, which is necessary in order to prescribe suitable antibiotics. With hematomyelia (epidural hemorrhage), the clot is removed. The causes of dyscrasia that led to hemorrhage must be identified and, if possible, eliminated. In this case, the appointment of drugs that affect the rheological properties and blood clotting is indicated (only under the control of a coagulogram).

It should be noted that diseases of the spinal cord should not be treated on their own. The fact is that this can only lead to aggravation of the disease and the appearance of various complications.. In order to avoid unpleasant consequences, it is recommended to contact a qualified neurologist as soon as possible. The prognosis of the disease depends on how extensive the lesion was and where exactly it was localized. As a rule, the earlier the correct treatment was started, the more favorable the prognosis will be. True, sometimes even with timely medical care, the patient still has persistent sensory and motor impairments, movement disorders and other residual symptoms.

So, vascular diseases that affect the spinal cord can lead to very serious consequences. Therefore, people who have discovered their symptoms in themselves should definitely contact a qualified doctor in order to undergo diagnosis and treatment. Inattention to one's own health, refusal to consult a doctor and non-compliance with his recommendations can cause a patient to lose his ability to work.

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• 10 necessary components food for healthy spine - in this report you will find out what should be daily diet so that you and your spine are always in healthy body and spirit. Very useful information!
• Do you have osteochondrosis? Then we recommend to study effective methods treatment of lumbar, cervical and thoracic osteochondrosis without medication.

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