Damage to the roots of the spinal cord. What diseases can affect the spinal cord? Video: Dr. Bubnovsky about rehabilitation after spinal cord injuries

Spinal cord diseases always require emergency treatment. And you need to contact only doctors, no self-treatment is unacceptable! After all, any diseases of the spinal cord are fraught with complications such as paralysis or paresis, and in some cases even death. Therefore, any suspicion of a deep back injury or inflammation should be a signal to call an ambulance. Doctors will prescribe treatment that will help preserve the quality of life of the victim in the future.

The spinal cord is part of the central nervous system. It supplies data and impulses to the brain. The main job of the spinal cord is to adequately transport the orders of the brain to the internal organs and muscles. It contains a variety of nervous tissue that signals from the brain to the body and vice versa.

Consists spinal cord from white and gray tissue, nerves and the cells themselves. In the middle of the spinal cord, in a multitude of nerves, is pure nervous tissue.

If pathologies or traumatic effects have involved the spinal region, this can result in great danger for normal life, the quality of human life. Moreover, there is a danger lethal outcome. Even small compressions caused, for example, can reduce sensitivity and mobility, and negatively affect the functioning of internal organs. There are a huge number of symptoms of such disorders, but one thing remains unchanged - damage and disease in the region of the spinal canal are immediately noticeable.

Symptoms

To a weak manifestation pathological processes dizziness, pain syndrome, increased pressure can be attributed. Pain and other symptoms may not always present in the same way. They can find attacks, or they can gradually become either stronger or weaker. They can also be chronic. It depends on the clinical picture and its details. Except pain syndrome pathological changes spine often cause:

• Decreased sensitivity and mobility;
• Urinary and fecal incontinence;
• Paralysis and paresis, full and partial type;
• Atrophic changes in the muscles.

If something puts pressure on the spinal cord, the result can be a large number of neurological problems. If the content of the spinal canal changes its position, or if pressure is simply applied to it, negative changes begin to occur in the body. Sometimes irreversible, and among other things, the brain can also be affected.

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If purulent and inflammatory processes occur, their foci often begin to put pressure on the spinal cord. This happens in many cases due to some third-party infectious diseases. The spine is well supplied with blood and is quite vulnerable to various infectious pathogens. Inflammation or suppuration may form here, which will pinch nerve roots or will begin to put pressure on the spinal cord, causing inevitable pain.

At intervertebral disc bulges back. As a result, damaged cartilage tissue can begin to press on the spinal cord, causing severe pain and neurological problems.

Spinal stenosis

Due to friction against each other, the vertebrae can build up osteophytes, sharp edges along their edges. If such growths become too large, there is a danger to the life and health of the patient. Also, the space in which the spinal cord is located can narrow due to changes in the position of the vertebrae, protrusions and hernial formations. To give freedom to the spinal cord, doctors often come to the conclusion that the only valid way Solve the problem with surgery.

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Tumors

Neoplasms may develop in the region adjacent to the spinal cord. Such as a cyst or a malignant tumor. Also, if oncological disease affected internal organs (for example, genitourinary system), metastases can penetrate into the vertebrae and spinal canal.

Myelopathy

When the tissues of the spinal cord begin to swell rapidly. Doctors do not always immediately discover the cause of the pathological process. Sometimes even the information obtained after magnetic resonance imaging may not paint the full picture.

This usually happens due to the fact that in the lungs or chest develops malignant neoplasm. Such puffiness is difficult to cure, and among their symptoms, difficult mobility, urinary and fecal incontinence quickly appear. In cases where doctors did not immediately pay attention to myelopathy and did not prescribe adequate treatment, a fatal outcome may occur.

summon fast development puffiness can also diseases such as sinusitis. This myelopathy occurs in acute mode and is infectious.

Diseases of the spinal cord often result in the fact that the blood supply to the spinal cord is impaired, and he begins to experience hunger. Cells begin to die, necrosis begins. The reason usually lies in traumatic effects on the spine. If it was already present intervertebral hernia, it can rupture, and its particles spread inside the spinal canal. This can be one of the causes of spinal starvation.

The clinical picture is as follows:

• Abruptly appeared weakness, "knocks down";
• Be sick;
• The body temperature drops;
• Severe headache;
• The patient falls into a pre-fainting state or even loses consciousness.

If a medical assistance Arrived in time, experts will be able to prevent a fatal outcome. But most likely, mobility impairments to one degree or another will remain for life.

Spinal blood circulation may be disrupted different reasons. Sometimes these are genetically defined features of the vascular system. The symptoms of a spinal infarction include a large number of manifestations that depend on which one. If the dorsal anterior artery has been occluded, tissue in front of the spinal canal will begin to die. The patient will almost immediately begin to suffer from disorders of the pelvic organs, the sensitivity of the legs will worsen. If such an artery is located in the neck area, sensitivity will decrease. upper limbs, the temperature will rise. Again, the person may lose control of bowel movements and urination.

When a disease, no matter what, affects the spinal cord, the manifestations do not allow themselves to wait. Sensitivity below the affected area immediately deteriorates. After all, these organs and muscles now perceive brain signals worse. Such a phenomenon may be accompanied by a feeling of "running goosebumps" and weakness of the corresponding area. It's called paresthesia.

Although this reduces the person's control over pelvic organs. It may also happen that instead of urinary incontinence, both the urge and the need to urinate disappear. This condition is dangerous because it accumulates poisonous substances in the body.

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If the nerve fibers of the spinal cord were torn, the muscles of the victim on a short time can shackle a strong spasm, tendon reflexes increase. The main symptom is pain. It differs from pain, say, with a hernia in that it is clearly localized in the middle of the back, exactly along the line of the spine. A life-threatening symptom will be a complete failure of the rectum and Bladder. In this case, the pain syndrome will be given to the femoral and inguinal region.

No attempts self-treatment are not allowed. Even medications only a qualified doctor after diagnosis has the right to prescribe.

As a rule, time does not endure, and as soon as doctors begin to work with the patient, they simultaneously move on to medical care and history taking.

To improve blood circulation in the spinal cord and prevent necrotic tissue death, agents such as nicotinic acid or Cavinton are used. Since the bladder may refuse to work, diuretics are prescribed. Thin the blood with aspirin or other similar drugs, especially if blood clots are present.

After acute period has ended and the doctors no longer worry about the life of the patient, the rehabilitation period begins. To restore the mobility and sensitivity of tissues, physiotherapy, exercise therapy, massage treatments. In addition, it will be necessary to improve the permeability of impulses through the nerves. Sometimes medications from the group of muscle relaxants are used to minimize unnecessary muscle spasms.

Surgical intervention is necessary for hernias, compression fractures, and sometimes a change in the position of the vertebrae. By themselves, these conditions are not vascular pathologies back, but they often develop a lack of nutrition of the spinal canal. When inflammation in abscesses begins to affect the area of ​​​​the spinal cord, in urgently it is incised and the contents are pumped out so that purulent accumulations do not affect the nervous tissues.

The spinal cord is an organ of the central nervous system involved in the formation reflex arc and performing other neurological functions.

The organ is located in the spinal canal of the spine, has a length of about 45 cm and a width of about 1 cm. Nerve roots depart from it. Diseases of the spinal cord lead to disruption of the functions of this anatomical structure and the appearance of a pain syndrome of significant severity. The origin of the pathology may be different, but the symptom complex of the lesion is usually similar in all cases.

Types and classification of diseases

The diseases of the group under consideration are classified mainly according to the type of pathological process leading to damage to the brain tissue. There are the following types of pathology:

• Vertical injuries of a traumatic nature;
• transverse myelopathy;
• Purulent-inflammatory processes;
• Tumor processes;
• Infectious and radiation myelopathy;
• Vascular malformation;
• Chronic paraparesis;
• Combined degeneration.

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Vertical injuries are SC injuries caused by spinal compression ( compression fractures). This causes compression nervous tissue, its edema develops and functional failures occur. Injuries at the level of the first cervical vertebrae often lead to the death of the victim until first aid is provided to him.

transverse myelopathy

Myelopathies are conditions associated with gradual atrophy of spinal cord tissues, which develops as a result of trophic disorders, toxic effects, dysmetabolic or ischemic phenomena. An example of diseases leading to the appearance of myelopathy can be tuberculosis, diabetes, osteomyelitis, oncological processes.

Purulent-inflammatory process

Purulent-inflammatory processes include abscesses, arachnoiditis and others. bacterial infections flowing in the area of ​​the spinal canal. The disease leads to the appearance of severe symptoms, which in most cases are reversible and disappear completely after proper treatment.

Tumor

Tumors can be located on the surface or inside the body, as well as in the epidural space. The rate of onset of signs of the disease depends on the rate of development of the neoplasm and the degree of sensitivity of the patient to pain. Often these diseases are incurable and lead to the death of the patient.

Infectious and radiation myelopathy

Myelopathies of radiation origin are often iatrogenic and develop after the course radiotherapy for the treatment of oncological diseases. Infectious disorders occur after poliomyelitis, with the development of AIDS. The process is characterized by the appearance of necrotic areas on the spinal cord.

Vascular malformation

Vascular malformations occur when the vessels supplying the spine are damaged (hemangioma, thrombosis, compression). Clinical manifestations of pathology in this case are due to ischemic phenomena.

Chronic paraparesis

Chronic paraparesis is a violation of the sensitivity of the limbs caused by degenerative changes in the spinal cord. The disease develops as a result of spinal stenosis, cervical spondylosis, transverse myelitis.

Combined degeneration

Combined degenerations of non-traumatic origin develop with a lack of vitamin B12. The essence of the disease is a complex lesion of the spinal cord. Patients have a combination of ataxia, paraparesis and other pathological processes. The disease develops gradually, so timely detection its consequences can be eliminated completely.

Symptoms

The symptom complex that occurs when the SM is damaged directly depends on which part of the organ the damage is located. So, with a lesion in the lower part lumbar in a patient, the activity of the bladder, legs, anus, and large intestine is disturbed. If the damage is localized in the upper part of the lumbar region or in the lower part of the chest, the liver, stomach, gallbladder, small intestine, kidney. The spinal cord, damaged in the region of the upper shoulder girdle, leads to failure of the heart, diaphragm, and lungs. The cervical region of the SM, which innervates the arms, head, and neck, causes disturbances in the functioning of these structures.

Apart from specific features lesions of certain departments, symptoms of disease or damage to the spinal cord are as follows:

1. Decreased muscle tone;
2. paresthesia;
3. Paralysis, paresis;
4. Decreased sensitivity in the focus of the disease, located in close proximity to the spinal cord;
5. Complete loss of sensation below the point of injury to the spinal cord;
6. Violation of tissue trophism;
7. Pain sensations, with compression of the spinal cord, localized along the midline of the back, with compression or inflammation of the roots - in the area innervated by them.

Interestingly, the symptoms of damage to the structure in question occur on the side opposite to the focus of the pathology. Thus, damage to the CM at the level of the neck on the right can cause monoparesis on the left and vice versa. This is because the roots spinal nerves arranged crosswise.

Note: the effect of the disappearance of sensitivity below the point of damage to the spinal cord is actively used in anesthesiology. The doctor can block sensation in the lower body by injecting an anesthetic into the spinal canal at the appropriate level. In this case, the patient remains conscious, and the specialist can monitor his condition. A similar method of anesthesia is often used during a caesarean section.

Diagnostic methods

Diagnostics neurological pathology is based primarily on visual inspection and functional examination of the patient. In this case, a study of the sensitivity of the skin, motor functions limbs, carefully collected anamnesis. An important diagnostic sign of spinal cord injury may be conditions that the patient himself does not consider to be associated with CNS diseases and which he is embarrassed to report to the doctor (urinary incontinence, spontaneous defecation). Therefore, the history taking must be carried out carefully, taking into account indirect signs one pathology or another.

Of the hardware techniques for diagnosing diseases of the spinal cord, radiographic methods of research and ultrasound are used. With the help of ultrasound (dopplerography), a specialist can obtain data on the state of the vessels that feed the spinal cord, and the speed of blood movement in them. RG, CT scan and magnetic resonance imaging allow you to visually determine the source of damage to the anatomical structure, its size and features. After collecting an anamnesis and conducting hardware examinations, the patient is asked to fill out a special questionnaire on pain, proposed by Professor Matveev S.V. This document allows you to assess the patient's condition from his own point of view and compare it with a real-life pathology.

Treatment

Depending on the type of disease, the characteristics of its course and the condition of the patient, treatment can be conservative or surgical. At the same time, surgical techniques are more often used for mechanical damage to the organ, as well as for tumors that do not affect deep structures spinal cord.

Conservative therapy

Drug therapy for most diseases of the spinal cord is carried out in the same way as therapy for lesions of the spinal nerve trunks. Means belonging to the following pharmacological groups are used:

• ganglion blockers (kvateron, benzohexonium);
• analgesics (ketorol, ketonal);
• agents that improve tissue trophism (calcium pantothenate, multivitamins);
• correctors of psychoemotional disorders (tizercin, haloperidol).

Apart from medicines, the patient is prescribed physiotherapy procedures, which include electrophoresis, radon baths, mud applications, massage in the absence of contraindications, UFO. Inoperable oncological neoplasms require the appointment of radiation therapy and chemotherapeutic drugs.

Note: in recent times World Wide Web users have questions about the possibility of exchange blood transfusion in SM diseases. Therefore, it is worth noting that with such a pathology as a disease of the spinal cord, ZPK is not prescribed.

Surgery

Surgical treatment is performed when conservative therapy turns out to be ineffective. First of all operational way restore the integrity of the body when it traumatic injuries. The organ is placed in place, stitched, after which the patient must adhere to strict bed rest. When tumors are removed, the duration of the patient's stay in bed is reduced, since most of the operable formations are located on the surface of the organ. Accordingly, the operation is less traumatic.

Prevention

Measures to prevent neurological diseases are primarily in the prevention of back injuries. You should correctly select the mode of work and rest, avoid playing sports that can harm the body (weightlifting, acrobatics). In addition to the above, it is recommended to take regularly multivitamin complexes to compensate for the deficiency of vitamins and to carry out activities that enhance the activity of the system immune protection: hardening, good nutrition, morning exercises, prevention of hypothermia. This will reduce the likelihood of tumor formation.

Spinal cord disease is a serious pathology that can only be treated qualified specialist familiar with modern therapeutic and surgical techniques. Therefore, the use folk remedies in such a situation is unacceptable. At the first sign of illness, you should consult a doctor for examination and appointment necessary ways therapy.

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With a fracture and subluxation of the vertebrae, a contusion of the spinal cord is observed. The injury has a poor prognosis for treatment. Accompanied internal bleeding, conduction disturbance, necrosis.

Symptoms of a back injury

As the condition improves and the functions of the spinal section normalize, you can consider the symptoms characteristic of a spinal cord injury and put accurate diagnosis. The international classification of diseases ICD 10 helps to determine the injury.

To damage every department spinal column have their own characteristics.

Neck injury

A severe spinal cord contusion in the neck is accompanied by crushing of soft tissues, which is an irreversible (organic) consequence of the injury. characteristic symptoms is a violation of visual auditory and motor functions, loss of memory and coordination of movements.

Trauma in the chest area

With a severe bruise, the patient complains of heart pain, gastrointestinal disorders and urethra. Swipe often becomes a catalyst for respiratory failure and the occurrence of hematomas.

Complaints of the patient with a bruise, help to carry out differential diagnosis and make an accurate diagnosis.

Trauma to the lumbar

The consequences of a severe bruise lead to a violation of the mobility of the spinal column - the patient cannot stand, sit, or remain still long time.

Over time, constantly deteriorating blood circulation is diagnosed lower extremities, felt constant weakness, there is progressive atrophy of muscle tissue. In 50% of cases, the injury is accompanied by swelling in the ankle and ankles.

What threatens injury

The degree and classification of the bruise affects the consequences of the injury.

The prognosis of the disease is relatively unfavorable and depends on the degree of injury and clinical manifestations and signs of injury. Medical assistance has a supportive effect. At complete break full recovery spinal cord function is impossible.

Treatment for injury

During the entire period of hospitalization of the patient, make sure that pressure sores do not appear. Violation of the normal blood supply leads to a slow metabolism. As a result, bedsores appear much faster than in patients with other diagnoses.

Relatively recently, surgical treatment has been developed and implemented, in which an electrical effect is exerted on the nerve endings. This method allows even patients with chronic injuries to recover.

Rehabilitation after an injury

As a rule, whether the patient will be able to stand up after an injury is predicted in the first two days after the injury. If there is no restoration of basic functions, we are talking about an organic (irreversible) lesion. According to the results of the study, a course of rehabilitation and drugs for treatment are prescribed.

As a rehabilitation therapy, visits to the following procedures are recommended:

Independent recovery and rehabilitation is impossible. Spinal injuries require professional help. Contacting rehabilitation center is mandatory.

How long does it take for the spinal cord to recover after an injury?

Full recovery will take much longer. Even with a well-prescribed course of therapy and undergoing treatment in Israel (one of the best medical centers to restore body functions), the consequences of the injury will be felt after 5-10 years. AT severe cases full recovery never occurs.

Folk remedies for injury

The following recipes will help remove puffiness and normalize blood circulation:

• For 1 liter of vodka, 30 gr. burdock root, and crushed violet tricolor. Creeping wheatgrass and veronica grass are added to the herbal composition, 20 gr each. each. The mixture is poured with vodka and infused for 5 days. Used in the form of compresses.
• For half a liter of vodka, equal 20 gram servings of coltsfoot and oregano are taken. The resulting composition is settled for 3 days. Used as wraps and compresses.

Non-traditional treatment does not replace professional medical care. For any back injury, you should contact the nearest medical center.

The spinal cord belongs to the central nervous system. It is connected to the brain, nourishes it and the shell, transmits information. Main function spinal cord - 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 in white and gray matter: white is made up of nerve processes, 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 most mild symptoms diseases of the spinal cord 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 suffers cervical region 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. Operational solution 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 is not always able to accurately determine clinical picture. There is always one picture on the CT scan results: severe swelling 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 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 others. inflammatory diseases 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 due to severe circulatory disorders, the spinal cord begins to starve, its functions are so upset that it leads to 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 dystrophic changes in the tissue structure of the spinal cord. Violations cause (osteophytes), which ultimately compress the spinal canal. The pressure can be strong and cause stenosis of the central canal. Stenosis 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 of its nerve endings. The disease may be congenital pathology, and acquired. Stenosis can be caused by many processes:

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

Sometimes congenital anomaly worsened acquired. 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: Basic clinical signs diseases of the spinal cord are: loss of sensation below a certain level ("level of sensory 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 tract causes quadriplegia or paraplegia with increased muscle tone, increased deep tendon reflexes and positive symptom Babinsky.

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: Back pain in the midline diagnostic value to localize 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 of the thoracic spine; radicular pain may indicate a more laterally located lesion; pain associated with injury lower section spinal cord (medullary cone), can radiate to lower part 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 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 of the cervical region.

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 CSF pathology.

Intramedullary lesions: Accompanied by burning pains, the localization of which is difficult to determine, loss of pain sensitivity with a preserved sense of joint position, with 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 common malignant tumors affect prostate, 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. Cause: Minor injury 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 intervertebral disc: formation of a herniated disc in the cervical and thoracic occurs less frequently 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 a rash, most often of a 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 infectious process, multiple sclerosis, carcinoma. Somatosensory evoked responses may be pathological.

Treatment:

Compression caused by a tumor: With epidural metastases, large doses of glucocorticoids (to reduce swelling) and local exposure 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 urgent surgical intervention for draining an 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; infections urinary tract; bedsores; TELA.