Syndrome of a horse tail
Syndrome of a horse tail — the clinical simptomokompleks arising at defeat of a bunch of nervous trunks of terminal department of a spinal cord. The main symptoms are weakness in the lower extremities, touch frustration in a zone of an innervation of the affected nerves, pelvic dysfunction as a delay. It is diagnosed according to neurologic survey, establishment of an etiology of defeat is carried out by means of MPT, KT, a lyumbalny puncture, the analysis of tserebrospinalny liquid. Treatment includes conservative and surgical methods, in the subsequent complex rehabilitation is carried out.
Syndrome of a horse tail
The spinal cord comes to an end at the level of the first lumbar vertebra, spinal nerves of underlying segments (lumbar, sacral, coccygeal) together with terminal thread form the bunch which received the name of a horse tail. Defeat of this education regardless of an etiology is shown by clinically uniform simptomokompleks allocated with experts in the sphere of neurology in a separate syndrome. Most often the syndrome of a horse tail is observed at patients of middle age. Pathology occurs at children seldom, arises owing to injuries and anomalies of a structure of the lower departments of the vertebral channel. Men get sick more often than women as the significant role in developing of a disease is played by heavy lifting.
Reasons of a syndrome of a horse tail
As the leading mechanism of defeat of a terminal nervous bunch its compression in the vertebral channel acts. The hernia nuclei pulposi of lumbar department is the most common cause. Less often inflammatory and yatrogenny defeats meet. To the main etiofaktor capable to provoke a syndrome of a horse tail, belong:
- Hernia nuclei pulposi. Causes 15% of cases. It is formed owing to osteochondrosis of a backbone, the degenerate changes of an intervertebral disk leading to its prolapse. At education in lumbar department causes a sdavleniye of a horse tail.
- Traumatic damages. The lumbar vertebral and spinal trauma, a change of a sacrum, tailbone often are followed by direct traumatizing nervous fibers. Hemorrhages to the spinal canal, post-traumatic hematomas lead to their compression. Perhaps yatrogenny traumatizing – in rare instances a syndrome is a complication of epiduralny anesthesia, surgery of this area.
- New growths. Malignant tumors of a horse tail infiltrative sprout nervous bunches, causing destruction of nervous fibers. Good-quality a neoplasia develop from covers of nerves (nevrinoma), an ependima of the vertebral channel (ependimoma), fatty tissue (lipoma), brain covers (meningioma), are a factor of a compression of nervous backs.
- Deformations of a backbone. The congenital anomalies of a backbone in lumbar and sacral department causing narrowing of a terminal part of the vertebral canal create favorable conditions for a compression of the nervous bunches passing in it. The acquired deformations arise owing to age changes (deforming ), shifts of lumbar vertebras ().
The lumbar and sacral spinal nerves forming a horse tail innervate the lower extremities, genitalia, a bladder, an urethra, final departments of a rectum. Their damage at the initial stages is caused by irritation and hyper excitability of nervous fibers that is clinically shown by a pain syndrome. In process of destruction or a compression of nervous trunks the fading of their function leading to decrease or loss of sensitivity, paresis of muscles of the innervated zone is observed. Malignant a neoplasia are capable to destroy covers, walls of the vertebral channel, to give metastasises which are followed by symptoms of defeat of appropriate authority.
Symptoms of a syndrome of a horse tail
The pain syndrome becomes the first manifestation. Pains are localized in lumbar and sacral area, irradiate in the lower extremity on the party of defeat, an inguinal zone. Patients complain of hypersensibility (giperpatiya), unpleasant feelings (paresteziya) on localizations coinciding with pains. The pain syndrome amplifies at cough, sneezing, decreases in a semi-sitting position. Gradually the gipesteziya — the sensitivity reduction perceived by patients as a sleep develops.
Motive frustration demonstrate in the form of insignificant weakness in disteel departments of the lower extremity, bystry fatigue when walking. In process of progressing of pathological process symptoms gain bilateral character. Aggravation of paresis becomes the reason of considerable difficulties at independent movement. Disorder of sensitivity of genitalia leads to violation of the sexual sphere: at women the anorgazmiya is formed, men have an erectile dysfunction. Function of pelvic bodies suffers, patients lose feeling of fullness of a bladder, rectum. Result of lack of desires to an urination, defecation is the urine delay, a chronic lock.
When progressing defeat against the background of lack of treatment there is the patient's invalidization owing to walking violation. Overflow of a bladder due to the lack of a timely urination can be complicated by formation of a diverticulum, stagnation of urine — infection with development of an uretrit, cystitis, the ascending pyelonephritis. The long delay of a chair is followed by absorption of toxic substances in intestines that leads to the general intoxication of an organism. The Urgentny complications demanding emergency medical service are the sharp delay of an urination and a kalovy blockage.
In an initial stage the syndrome of a horse tail can be mistakenly diagnosed as a neuropathy of a femoral nerve, radiculitis, a lyumboishialgiya. The bilateral nature of changes, dysfunction pelvic and genitals indicates features of data of neurologic survey an inaccuracy of the similar diagnosis. For the purpose of specification of the diagnosis and detection of causal pathology conduct the following examinations:
- Survey of the neurologist. Defines lower distalny mono - or paraparesis, muscular hypotonia, atrophic changes. Reflexes are considerably lowered or are absent akhill, anal, bulbokavernozny (at men). Gipesteziya comes to light in the zones corresponding different to backs that demonstrates damage of several lumbar and sacral nerves at once.
- Backbone KT. More precisely, than the X-ray analysis, allows to confirm existence of bone anomalies, narrowings of the vertebral channel. A lack of a research is bad visualization of myagkotkanny structures.
- MRT of lumbar department of a backbone. Visualizes hematomas, a neoplasia, intervertebral hernias, gives the chance to estimate extent of narrowing of the vertebral channel. MRT badly displays a condition of bone structures therefore it is applied in addition to KT.
- Lyumbalny puncture. Lack of a likvor when carrying out a research (a dry puncture) is observed at the full block of likvorny space owing to an obturation of the channel by a large tumor, hernia. Hemorrhagic coloring of a likvor speaks about hemorrhage. For neoplaziya substantial increase of protein in tserebrospinalny liquid, is characteristic of an arakhnoidit, a miyelit — inflammatory changes.
- Histologic research. It is carried out in case of a new growth for verification of its look, definition of degree of a zlokachestvennost. The research is conducted intraoperatsionno with the subsequent control analysis of remote material.
Pathology needs to be differentiated from a polyneuropathy, mononeyropatiya of nerves of the lower extremity, manifestations of a lumbar and sacral pleksit. It is also necessary to distinguish a syndrome of a diskogenny, tumoral, traumatic, vascular etiology. In a difdiagnostika results of a magnetic and resonant tomography and other additional methods of a research are of great importance.
Treatment of a syndrome of a horse tail
Medical actions are directed to elimination of a cause of illness, a decompression of nervous backs, restoration of their functions. Often conservative methods of therapy are insufficient, are applied in combination with surgical treatment. Thus, treatment consists of the following components:
- Conservative therapy. Provides application of analgetics, glucocorticosteroids, miorelaksant. The expressed pain syndrome is the indication to purpose of medical blockade with introduction of local anesthetics and corticosteroids. At a delay of urine the bladder kateterization is made, at locks — cleaning enemas.
- Surgical intervention. Taking into account indications operations on removal of a tumor, a hematoma are carried out, in the presence of hernia of a disk the diskektomiya is shown. Correction of congenital anomaly, stabilization of a backbone can be the purpose of surgical intervention. At impossibility of radical removal of a neoplasia carry out the palliative operations allowing to broaden the vertebral canal by a laminektomiya. As the indication to urgent intervention dysfunction of pelvic bodies, the accruing lower paraparesis acts.
- Rehabilitation. It is necessary for the most complete recovery of the lost neurologic functions. It is combined with purpose of vascular, neurometabolic medicines. It is carried out by efforts of reabilitolog, massage therapists, physiotherapists, doctors of LFK. Tumoral processes are a contraindication to physiotherapeutic procedures, massage.
Forecast and prevention
Success of therapy of a disease is defined by its etiology, prevalence of process, current duration without holding medical actions. Timely treatment allows to eliminate neurologic deficiency almost completely. Without adequate therapy over time in the struck trunks of a horse tail there are irreversible changes, restoration of their function becomes impossible. Specific methods of prevention of this pathology are absent. Injury prevention, an exception of onkogenny influences, observance of the operational equipment when carrying out interventions on lumbar and sacral department of a backbone belong to the general actions.