This pathology is a complex neurological symptoms, which are caused by displacement and deformation spinal cord due to the impact of any neoplasm on it, or displacement of the vertebra due to spinal cord injury.
Normally, the spinal cord is protected by the framework of the vertebral bones. In the event of the development of certain diseases or injury, compression of the spinal cord occurs, which disrupts its normal function.
Why does spinal cord compression occur?
This pathology can develop through the following reasons:
Fracture of one or more vertebrae or destruction of intervertebral discs, as well as due to bleeding in the spinal cord. Compression can also be caused by infection or inflammatory disease, the development of a tumor in the spine or directly in the spinal cord.
Another cause of compression may be pathology of a blood vessel.
In the case of powerful compression, all nerve impulses that are transmitted through the spinal cord are blocked. If measures to detect the pathology and treat it are taken in a timely manner, the functioning of the spinal cord is completely restored.
Symptoms of pathology
Depending on which part of the spinal cord is injured, the sensitivity of certain areas depends. For example, a decrease or complete loss of sensitivity or even paralysis can occur due to injury or damage to the lower part of the spinal cord.
If a tumor develops, or infectious disease, which develops directly in the spinal cord or in proximity to it, slowly, gradually compresses the brain, causing slight pain and tingling in this area. Patients also complain of general weakness and loss of sensitivity. These symptoms persist for several days.
Slow compression may be caused by the presence of bone modifications resulting from damage to the bones of the spine or the development of a neoplasm.
If the blood supply to the spinal cord is disrupted, for example due to injury, loss of sensitivity and paralysis develops rapidly and occurs within a few minutes.
Diagnosis and treatment
Since nerve cells and methods of transmitting nerve impulses are in certain formed groups, the doctor can accurately determine the area of the lesion (of course, for this he needs to analyze the symptoms and study the test results).
For example, an injury to the thoracic spine can cause loss of sensation, weakness lower limbs. Then dysfunction occurs Bladder and intestines. A nagging pain is felt in the area of injury.
Magnetic resonance or computed tomography is used to accurately determine the affected area. These methods help to accurately determine the area of compression and identify the cause that caused it.
In addition, myelography may be prescribed. This procedure involves the introduction of a contrast agent into the area of possible damage. X-rays are then used to determine the exact location of the spinal cord injury.
In addition, the myelography method makes it possible to determine the extent of the disorder. Certainly, this method more complex than traditional magnetic resonance and computed tomography. However, it is the most accurate and allows you to resolve all issues related to spinal cord compression.
However, without exception, all of the methods listed above make it possible to detect the presence of a fracture or displacement of the vertebrae. With their help, you can accurately determine the presence of destruction of the intervertebral disc, the development of a tumor in the spinal cord or an inflammatory, infectious disease.
Treatment depends on the stage of the pathological process and its etiology. But you need to understand that treatment carried out on early stage, is almost always more efficient than when the process is running.
If a malignant tumor develops that causes compression of the spinal cord, radiation therapy is performed. If necessary, surgical decompression is used. Often both treatment methods are used simultaneously.
If diagnosis and treatment are carried out promptly and adequately, motor functions will be restored. Otherwise, compression of the spinal cord can cause disability to the patient, causing him permanent disability.
Possible complications
These include bedsores, disorders gastrointestinal tract, violation of thermoregulation. May also develop purulent meningitis, epiduritis, paravertebral abscess.
Description:
Normally, the spinal cord is protected by the bones of the spine, but some diseases are accompanied by compression and disrupt its normal functions. With very strong compression, all nerve impulses traveling along the spinal cord are blocked, and with less strong compression, only some signals are interrupted. If compression is detected and treatment is started before the nerve tracts are destroyed, spinal cord function is usually fully restored.
Causes of spinal cord compression:
The cause of compression may be a vertebral fracture, rupture of one or more intervertebral discs, hemorrhage, infection (abscess in the spinal cord membranes) or tumor growth in the spinal cord or spine. Abnormal blood vessel(arteriovenous shunt) can also compress the spinal cord.
Symptoms of spinal cord compression:
Depending on which area of the spinal cord is damaged, the function of certain muscles suffers and sensitivity in certain areas is impaired. Weakness or reduced sensation or complete loss of sensation usually develops below the level of injury. A tumor or infection located directly on or near the spinal cord can slowly compress the spinal cord, causing pain and tenderness at the site of compression, as well as weakness and changes in sensitivity. As the pressure worsens, weakness and pain progress to paralysis and loss of sensation. This usually happens over a period of several days or weeks. However, if the blood supply to the spinal cord is interrupted, paralysis and loss of sensation can occur within minutes. Most gradual compression of the spinal cord usually results from changes in the bones caused by a degenerative lesion of the spine or a very slowly growing tumor. In this case, the person experiences little or no pain and changes in sensitivity (for example, tingling), and weakness progresses over many months.
Diagnostics:
Because the nerve cells and the impulse transmission pathways are grouped in a certain way in the spinal cord, by assessing the symptoms and conducting an objective examination, the doctor can tell which part of the spinal cord is affected. For example, damage to the thoracic spine causes weakness and numbness in the legs (but not the arms) and leads to impaired bladder and bowel function. In the place where the spinal cord is damaged, a person often experiences an uncomfortable “tightening” sensation. CT scan(CT) or magnetic resonance imaging (MRI) can usually locate the spinal cord compression and find the cause. Your doctor may also recommend a myelogram. During this procedure, a radiopaque substance is injected into the space around the spinal cord, and then the X-ray image is used to determine where the contrast filling is disrupted, that is, the deformation of the space is determined. Myelography is more complex than CT or MRI, and is somewhat more inconvenient for the patient, but it removes all the questions that remain after MRI and CT. The listed studies can reveal a fracture, “flattening” or displacement of the bones of the spine, rupture intervertebral disc, tumor
bones or spinal cord, accumulation of blood and. Sometimes necessary additional tests. For example, if tests reveal a tumor, a biopsy must be done to determine whether it is cancerous.
Treatment of spinal cord compression:
For treatment the following is prescribed:
Spinal cord compression is treated depending on its cause, but in any case, they try to eliminate it immediately, otherwise the spinal cord may be permanently damaged. Surgery is often required, although pressure caused by some tumors can be relieved by radiation therapy. Corticosteroids, such as dexamethasone, are usually prescribed to reduce swelling around the spinal cord that is exacerbating the compression. If the spinal cord compression is due to infectious process, you must immediately start taking antibiotics. The neurosurgeon drains the pus-filled area of inflammation (abscess), for example, he can suck out the pus with a syringe.
Spinal cord compression is one of the most severe neurological diseases spine, in which compression of the spinal column occurs. There can be a great many reasons for this, and treatment is most often only surgical. The prognosis depends entirely on what became the provoking factor and how quickly help was provided.
Causes
There can be many reasons for compression, and some of them can only be discovered after research. Among the main provoking factors are:
- large intervertebral discs.
- Disc displacement.
- Discs falling out.
- Back injuries that lead to spinal cord damage or swelling.
- in the epidural space.
- Tumors, both inside and outside the vertebrae.
- Metastases of primary oncology.
There are several types of this disease, which will depend on the causes. For acute form These are comminuted injuries, displaced compression fractures, or epidural hematoma.
For subacute - these are tumors and metastases, abscesses and hematomas, damage to the discs between the vertebrae.
Both conditions can develop in literally a matter of hours.
But there is a third type - chronic, which develops slowly, and sometimes this process stretches for several years. This should include causes such as protrusions and hernias, vascular malformation, and primary tumors.
How it manifests itself
Spinal cord compression can develop in any part of the back, including the cervical region. In this case, not only the nerve root is compressed, but also the vessel that is located nearby. This causes either radicular syndrome or spinal cord infarction.
The first symptom that patients will complain about is pain. But it appears only if there is compression of the nerve root, which is responsible for pain impulses. If this is not the case and only the spinal cord is affected, then there will be no pain.
The second important manifestation is paresthesia, that is, numbness of the limbs, a feeling of crawling and other unpleasant phenomena. If the neck is affected, they will also suffer upper limbs. If a violation in lumbar region, then the legs will be affected.
- Lack of any sensitivity.
- Tetraparesis.
- Muscle weakness.
- Loss of coordination.
- Atony of the bladder.
- Atony of the rectum.
Diagnostics
An MRI is required to make a correct diagnosis. If for some reason it is not available, then CT myelography is also suitable. This will show what caused the lesion, at what level it occurred, and what tactics the doctor should choose to save the patient from the pathology.
How to get rid
Compression of the spinal cord in the thoracic region, as in all others, is most often treated with surgery. At acute version during the course of the operation, surgery is required as soon as possible so that the swelling caused by the injury does not cause irreversible changes in the nervous tissue.
Most often used for pain relief narcotic analgesics. Corticosteroid treatment is also used to help relieve swelling and inflammation.
But most often compression occurs due to the tumor. The signs in this case will be expressed very well.
Particularly dangerous are tumors that are of secondary origin, that is, they are metastases, as well as those related to oncology. They grow very quickly, which means that compression occurs in just a few months, and the patient may not even be aware of it. The only treatment is removal of the tumor.
The main indications for surgery should be considered an increase in sensory or motor disorders, unstable position of the spine, the presence of an abscess or hematoma.
If there are many areas of compression, radiation therapy is used, the same is indicated for contraindications to surgery, as well as for slow development of the process.
The prognosis will depend entirely on both the cause and how exactly the cause of the compression was removed, and how quickly this was done.
Diagnosis is based on MRI results.
Much more often, compression is caused by a pathological process localized outside the spinal cord than inside it (intramedullary).
Acute compression. Common cause is an injury (for example, a depressed fracture of a vertebra with displacement of fragments, acute hernia intervertebral disc, hematoma caused by severe damage to the osseous-ligamentous apparatus, subluxation of the vertebrae or their displacement). Sometimes the cause of compression is abscesses, very rarely - a spontaneous epidural hematoma.
Chronic compression. Its cause is most often bone growths protruding into the lumen of the spinal canal in the cervical, thoracic or lumbar levels. The degree of compression can be increased by a herniated disc and hypertrophy of the ligamentum flavum. Less common causes include arteriovenous malformations.
Symptoms and signs of spinal cord compression
Sensory impairment may begin in the sacral segments of the spinal cord. Subsequently, complete loss of neurological function may suddenly occur, possibly due to the development of a secondary spinal cord infarction. Pain to percussion of the spine may indicate the presence of metastatic carcinoma, abscess or hematoma.
For intramedullary pathological processes burning sensations occur painful sensations, which are difficult to localize (unlike radicular pain syndrome), while sensitivity in the area of innervation of the sacral dermatomes most often remains intact. This type of lesion usually leads to spastic paresis.
Back pain is usually the first symptom. It occurs several weeks before the appearance of other symptoms and progresses steadily, depriving the patient of sleep at night. There may also be radicular pain that is misinterpreted, leading to a lengthy and unsuccessful search for the cause of chest and abdominal pain.
Symptoms of sensory disturbance may then occur in the form of paresthesia or a feeling of heaviness and twitching in the limbs.
Loss of sensation can only be detected by targeted testing. A pin prick is performed (spinothalamic tract), and deep muscular-articular sensation and vibration sensitivity (posterior longitudinal cords) are checked: selective compression of the anterior or posterior part of the spinal cord may occur. Preservation of sensitivity in the zone of innervation of the sacral nerves (usually in the dermatomes S3-S5) is a fairly reliable sign of intramedullary damage, in which the fibers of the lateral spinothalamic tract containing sensory conductors are not damaged. It should be remembered that the level of preserved sensitivity can only determine the most low level damage to the spinal cord, and several segments above the spinal cord may be intact.
Paresis usually begins with clumsiness but then progresses to complete loss of muscle strength.
ANS dysfunction: When the sympathetic pathways are involved, especially in the cervical and upper thoracic regions, hypotension, bradycardia, and even cardiac arrest may occur. Pain, urinary tract infection, bloating due to constipation or obstruction of the urine outflow tract may act as a provoking factor.
Sphincter dysfunction manifests as urinary retention or urge and can progress to painless bladder distension. Constipation is another consequence of spinal cord compression.
Fever should alert you to the possibility of an infectious nature of spinal cord compression.
Respiratory failure occurs when the spinal cord is compressed in the area of the upper cervical vertebrae, which is one of the causes of acute neuromuscular respiratory paralysis.
Damage to the conus medullaris occurs as a result of compression of the sacral segments of the spinal cord, which leads to relatively early onset disorders of urination and defecation, impotence, decreased sensitivity in the perianal area and anal reflexes; rectal and genital pain occurs later. The extensor plantar reflex is observed.
Damage to the cauda equina occurs as a result of compression spinal nerves cauda equina in the spinal canal below the first lumbar vertebra, which leads to flaccid, areflex and most often asymmetric paraparesis. The level of sensitivity corresponds to the saddle area up to the first lumbar segment (corresponding to the roots of the cauda equina).
Combined damage to the conus medullaris and cauda equina is manifested by a combination of signs of damage to the lower and upper motor neurons.
Inspection: Be aware of the possibility of spinal cord compression by tumor or metastases. Conduct a thorough examination of the patient, including examination of the mammary glands and thyroid gland.
Diagnostics
- MRI or CT myelography.
The presence of spinal cord compression can be suspected when back pain or radicular pain occurs in combination with neurological deficits in the motor or sensory sphere, changes in reflexes, especially if this lesion is localized at any segmental level. If possible, an MRI is immediately performed, and if it is not available, CT myelography is performed; at lumbar puncture a small amount of iohexol (a non-ionic low-osmolar contrast agent) is injected, which, moving in a rostral direction, stops at the level of the CSF block. In this case, a contrast agent is administered through a cervical puncture to determine upper limit block. If there is a suspicion of traumatic bone injuries (for example, fractures, displacements, subluxations) that require immediate immobilization, routine radiography is performed. However, CT makes it possible to better determine bone pathology.
Assessing the severity of spinal cord compression
An important indicator of the severity of the condition is the severity of paresis, loss of sensitivity and sphincter dysfunction.
Causes of non-traumatic spinal cord compression
Tumor
Primary:
- Intradural + extramedullary: schwannoma, meningioma; intradural + intramedullary: astrocytoma, ependymoma.
- Metastatic (usually extradural): breast, prostate, lungs, thyroid, gastrointestinal tract, lymphoma, myeloma.
Infections:
- Staphylococcal abscess, tuberculoma, infected dermoid cyst.
- Protrusion of the intervertebral disc (central).
- arachnoid, syringomyelia.
Hemorrhage.
Skeletal deformities: kyphoscoliosis, achondroplasia, spondylolisthesis.
Treatment of spinal cord compression
- Eliminate compression.
Treatment is aimed at relieving pressure on the spinal cord. Incomplete or recent onset neurological deficits may be reversible, but complete loss of function is rare.
In case of compression by the tumor, 100 mg of dexamethasone is immediately administered; emergency is carried out surgery or radiation therapy.
The choice of treatment method determines the diagnosis of the disease and the patient's condition. If the diagnosis is not yet known, it is necessary to establish it as quickly as possible, and also consult with specialists from the regional neurosurgical center. If it is known that the patient has a malignant neoplasm and there is a high probability of compression of the spinal cord by the tumor, then in most cases it is necessary to urgently perform radiation therapy. In patients with metastasis, any intervention without pain relief is not possible. You should always consult with an experienced oncologist.
- You should immediately perform an X-ray of the spine in a direct projection, which allows you to identify collapse of the vertebral body, areas of osteolysis or sclerosis. X-rays are performed to exclude a tumor process.
- The next research method is MRI or CT myelography. There is an urgent need to organize these studies. If this is not possible under conditions medical institution where the patient is hospitalized, the tactics for further management of the patient should be discussed with specialists from the regional neurosurgical center.
- The attitude towards the prescription of high doses of glucocorticoids is controversial: there is no clear evidence of benefit from their use in malignant neoplasms, and in poorly differentiated lymphoma they can even provoke the development of fatal tumor lysis syndrome. Discuss this issue with senior colleagues.
- If an infectious genesis of compression is suspected (fever, neutrophilia, increased CPV, etc.), it is necessary to perform a culture of blood, urine and sputum.
- Monitor hemodynamic parameters and observe manifestations of ANS dysfunction. Eliminate pain and take measures to prevent constipation.
- If bladder dysfunction is present, bladder catheterization may be necessary. If the patient is immobilized, prophylactic subcutaneous heparin (5000 units three times daily) should be started.
- If a patient has compression of the spinal cord at the level of the upper cervical vertebrae, as well as impaired ventilation, it is necessary to determine FVC and arterial blood gases.
- If the diagnosis remains unclear and neurosurgical intervention is not urgently required, the need for a CT-guided biopsy should be discussed with the radiologist.
Compression, or compression, of the spinal cord occurs when it is compressed by bone fragments as a result of a spinal fracture, tumor, abscess, damaged intervertebral disc, spinal cord injury, or other pathological conditions.
Neuropathological symptoms of spinal cord compression in medical practice considered as an emergency medical condition, regardless of the cause of origin, and require rapid diagnosis and treatment to prevent the development of a serious disease leading to long-term disability or disability that occurs against the background of the development of irreversible damage to the spinal cord.
Causes and signs of compression
Compression of the spinal cord roots can occur in any part of the spine, from the cervical spine to bottom backs. Signs of compression are a feeling of numbness, pain and muscle weakness that the patient feels. Symptoms may develop suddenly or gradually.
The human spine is divided into three different regions: cervical, thoracic and lumbar. Top part spine - cervical region. It supports the neck and consists of 7 vertebrae. Middle part of the spine - thoracic region, consisting of 12 vertebrae. Bottom part back - the lumbar region, which has five vertebrae. Spinal cord compression can occur in any of these parts.
One of the most common causes of spinal compression is age-related osteoarthritis, which can cause this syndrome. It affects the large bones of the spine and develops in patients over 50 years of age. Other conditions that can cause spinal cord compression include:
- abnormal spinal alignment;
- spinal injury;
- formation of a spinal tumor;
- some bone diseases;
- rheumatoid arthritis;
- infections.
These conditions usually develop at a rapid pace and are often sudden in nature. Compaction syndrome can occur at any age.
The main symptoms characterizing compression of the spinal cord manifest themselves in the form of back pain radiating to the legs. Wherein pain syndrome initially occurs in the area of the gluteal muscles, after which it begins to spread downwards, moving along the back of the thighs.
In some cases, spinal deformity occurs over several years and can cause following symptoms:
- pain and stiffness in the neck, back, or lower back;
- burning pain that spreads to the arms, buttocks, and back of the legs (sciatica);
- numbness, cramps, or weakness in the arms and legs;
- loss of sensation in the legs;
- difficulties with hand coordination;
- leg drop – weakness in the leg that leads to lameness;
- loss of sensation in the perineal area.
The diagnosis is made by a doctor based on an X-ray examination or magnetic resonance imaging of the entire spine. X-rays, obtained as a result of the examination, clearly show the deformation of bones, the formation of growths and spurs, or irregular curves of the spine.
Cauda equina syndrome: symptoms and causes
Cauda equina syndrome is a serious neurological condition that causes damage to the bundle of nerve endings that extend from the coccyx, the lower portion of the spinal cord. The nerve roots join the sacral plexus and influence the sciatic nerve.
Compression, trauma, or damage to the spinal canal area in the coccyx area can cause cauda equina syndrome. The syndrome is characterized acute pain, accompanied by loss of sensitivity and paralysis of the lower organs: buttocks, pelvic organs, legs.
This syndrome often has the following symptoms that require immediate attention: outpatient care doctor:
- loss of control over bowel and bladder functions;
- temporary or permanent loss of sensation in the area between the legs;
- severe pain and muscle weakness;
- gait disturbance.
The syndrome may occur due to:
- direct trauma;
- spinal stenosis;
- chronic inflammatory condition.
The most common injuries of this nature are lumbar punctures, severe burst fractures with posterior migration of fragments of the vertebral body, severe herniation of the spinal disc, unsuccessful spinal anesthesia, leading to trauma from catheters and high local concentrations of anesthetics around the cauda equina region, penetrating wounds (knife and ballistic injuries).
Spinal stenosis occurs in the lumbar region when the diameter of the spinal canal narrows. The development of degenerative processes such as osteoarthritis may be caused by developmental defects that were present at birth and in the first years of the patient's life.
Chronic inflammatory conditions and spinal diseases such as Paget's disease of bone, neurosarcoidosis, chronic inflammatory demyelinating polyneuropathy, ankylosing spondylitis and chronic tuberculosis can also trigger the syndrome.
When diagnosing cauda equina syndrome, the attending physician evaluates full story illness, examines the patient and refers for diagnostic tests.
To assess the severity of the disease, the doctor may prescribe the following to the patient:
- X-ray examination;
- magnetic resonance imaging (MRI);
- computed tomography (CT).
Who diagnoses the disease
Spinal cord compression and cauda equina syndrome can be diagnosed by a team of doctors consisting of an arthrologist, rheumatologist, practicing bone surgeon, internist and neurologist.
Many causes of spinal cord compression cannot be prevented, but can be alleviated by measures to prevent spinal cord compression caused by gradual wear and tear. The syndrome can be prevented through regular physical exercise, strengthening muscles, supporting the back, allowing you to keep the spine flexible.
It is essential to maintain good posture and healthy image life. Patients are recommended to sleep on a hard mattress and use hard chairs and armchairs that support the natural curves of the back.
An important condition is maintaining normal body weight. If the patient has overweight, the bones of the back are subject to excessive stress, which can contribute to the development of symptoms of spinal cord compression.
