Compression miyelopatiya – the heaviest complication of diseases of nervous system which cornerstone the sdavleniye of a spinal cord various educations is: bone splinters of vertebras at a trauma, disk hernia, a tumor, a hematoma. The main symptoms of a miyelopatiya are loss of motive and sensitive function below the place of defeat. Besides, violation of work of internals is observed. For diagnostics of a compression miyelopatiya the computer tomography, a X-ray analysis, a miyelografiya are used. Treatment of a sdavleniye of a spinal cord, mainly, quick.
The term "compression miyelopatiya" is understood as damage of substance of a spinal cord owing to pressure upon it by any education with development of motive and sensitive violations. The compression miyelopatiya is not an independent disease, arises as a complication of various pathological processes in a spine column or spinal covers.
Major factors which lead to damage of nervous ways at a sdavleniye of a spinal cord are: direct destruction of its substance pathological factor; perezhaty large blood vessels at the expense of which food of nervous tissue is broken and the necrosis develops. Than longer the compression duration, especially an important role are played by change of intensity of a blood-groove.
Reasons of a compression miyelopatiya
Depending on development speed the sdavleniye of a spinal cord can be sharp, subsharp or chronic. Sharp compression miyelopatiya develop at a sharp one-stage sdavleniye of substance of a brain with damage of its structures and pronounced neurologic symptoms. From the moment of influence of the damaging agent before emergence of clinical symptoms there pass minutes-hours. Can be the reasons of such state: spine injuries, hemorrhage under covers of a spinal cord. The sharp sdavleniye can also represent the result of tumoral process or epiduralny abscess.
Among spine injuries which can become the reason of a syndrome of a sharp compression miyelopatiya the important place is taken by compression fractures of vertebras with the shift of otlomk. They arise at strong axial load of a backbone, for example, heading about a bottom when diving in the unfamiliar place. Other injuries of a spine column are dislocations, incomplete dislocations, shifts of vertebras relatively each other. In all these cases the spinal cord is squeezed by bone otlomka or clamped in the spinal channel.
Hemorrhage under covers of a spinal cord can arise at the back injuries, administration of drugs reducing the curtailing activity of blood (anticoagulants, for example, ) as a complication of medical manipulations (a lyumbalny puncture, epiduralny anesthesia). The spinal cord settles down in the bone channel formed of openings in a body of vertebras and is surrounded with several covers. Blood from the damaged vessel, most often is a vein, streams in space between a bone and a firm cover of a spinal cord. As the vertebral channel rather narrow, and blood is not capable to compress, the formed hematoma pushes aside a spinal cord and squeezes it. Sdavleniye on an extent from several days to 1 — 2 weeks conditionally is called a subsharp compression. It can arise at a rupture of a hernia nuclei pulposi, rapid growth of metastasises of tumors, formation of purulent abscess.
The tumor of a spinal cord formed of its covers or a new growth of tissues of vertebra, long time can not have an effect. However while nervous tissue ceases to compensate damage, the syndrome of a subsharp sdavleniye of tissues of brain develops. The same occurs at formation of purulent abscesses under a firm cover (most often arises at tuberculosis and osteomyelitis of a backbone). At increase in a purulent zatek up to certain sizes there is a sdavleniye of a spinal cord. At backbone osteochondrosis fragments of hernia of a disk or protrusion of a part of a fibrous ring, osteofita (the bone growths which are formed around the vertebral channel and deforming it) can render a compression. Feature of a chronic compression miyelopatiya is slow increase of symptoms (for many years) and ability of a spinal cord long time to compensate damages.
Also can lead slowly growing tumors of covers and vertebras to a gradual sdavleniye of a spinal cord.
Symptoms of a compression miyelopatiya
At diagnosis usually do not specify type of a compression miyelopatiya in neurology. However in practice it is accepted to divide injury of a spinal cord from a sdavleniye into 3 types: sharp, subsharp, chronic. Clinical manifestations of a compression miyelopatiya directly depend on type of a sdavleniye, department of a spinal cord (cervical, chest, lumbar) and damage center locations in relation to the main nervous ways.
The spinal cord in the functional relation is not uniform structure. In its forward part the motor neurons which are responsible for the movements of skeletal muscles settle down; in back – sensitive nervous cages, and on each side – the centers responsible for work of internals. Depending on on what part of a spinal cord pressure of the damaging factor prevails, these or those clinical symptoms will be expressed.
Sharp, subsharp and chronic forms of a miyelopatiya differ in the speed of development of symptoms of a disease and degree of expressiveness of the lost functions. The heaviest on the manifestations is the sharp sdavleniye of a spinal cord. At it there is a one-stage loss as motive (sluggish paralysis develops), and sensitive function of the parts of the body located below a damage zone work of a bladder and rectum is broken. This state is called spinal shock. After a while sluggish paralysis passes into spastic, there are pathological reflexes, convulsive reductions of muscles, development of resistant rigidity of joints (contractures) is possible.
Compression in cervical department. The chronic compression miyelopatiya, as a rule, begins with dull aches in muscles of a neck, a nape, the top part of a breast, shoulders and hands. In the same areas there are disorders of sensitivity in the form of feeling of crawling of goosebumps, a sleep. Later muscular weakness in hands joins, decrease in a tone, an atrophy, can be observed twitchings of separate muscle fibers. If the site of a sdavleniye is located in the first and second cervical segments, signs of damage of a facial nerve – violation of sensitivity on a face can join. Emergence of cerebellar symptoms – unstable gait, trembling of hands is possible.
Sdavleniye in chest department. Compressions of a spinal cord in these departments arise rather seldom. Weakness and increase in a tone in legs, and also violation of sensitivity in a back, a breast, a stomach is characteristic of them.
Compression miyelopatiya in lumbar department. In lumbar department pains in muscles of buttocks, hips, shins, change of sensitivity in the same areas are characteristic of a chronic sdavleniye of a spinal cord. With increase in time of influence of the injuring factor weakness in muscles, decrease in their tone, reduction in sizes joins (atrophy). Gradually sluggish peripheral paresis in one or both legs develops.
Diagnostics of a compression miyelopatiya
The gold standard in diagnostics of a compression miyelopatiya is performance of KT and MPT of a backbone. In pictures it is possible to see distinctly not only the reasons which led to a sdavleniye but also a condition of tissues of brain.
At impossibility to make a tomographic research, and also at suspicion of spinal fracture or dislocation of vertebras, the X-ray analysis of a spine column in three projections is used. According to indications the lyumbalny puncture with a research of cerebrospinal fluid is carried out. The miyelografiya – a special radiological method which cornerstone introduction to subarakhnoidalny space of contrast is can be used. After distribution of dye a series of pictures which allow to define at what level is made there was a sdavleniye of a spinal cord.
Treatment of a compression miyelopatiya
Sharp and subsharp miyelopatiya demand immediate surgical treatment. Its purpose is the removal of the agent injuring a spinal cord in the shortest possible time allowing to lower a damage rate of nervous ways. Also surgery is necessary at a chronic sdavleniye of a spinal cord a tumor regardless of a limitation period of a disease and size of a new growth.
At the chronic compression miyelopatiya caused by osteochondrosis, the neurologist can offer the two-stage scheme of treatment. At first a course of conservative therapy which includes is conducted: resolvents; vitamins; the medicines restoring cartilaginous tissue; physiotherapy; LFK; carrying orthopedic corsets.
If conservative techniques do not render effect or the progressing increase of symptoms of a sdavleniye of a spinal cord comes to light, surgical treatment is applied. Depending on the reason of a compression miyelopatiya the fasetektomiya, a laminektomiya, removal of vertebral hernia and bone growths, replacement of a disk by an artificial endoprosthesis, removal of a hematoma and drainage of a cyst of a spinal cord, a resection of a wedge of Urban, etc. can be carried out.
An important role in recovery of patients with a compression miyelopatiya is played by regular sanatorium treatment and annual rehabilitation courses in specialized medical institutions. The daily individual remedial gymnastics made by the doctor of LFK is of great importance.
Forecast and prevention
In spite of the fact that the sharp compression miyelopatiya – the heaviest pathology form on the clinical manifestations, at in time the begun treatment it is the most favorable according to the forecast. The reason of it that at a sharp form profound changes in muscles and peripheral nerves do not manage to happen. Therefore at elimination of a pathological factor perhaps bystry restoration of conductivity on a spinal cord and full return of the lost functions.
At chronic compression miyelopatiya in muscles, nerves, and also in the most spinal cord there are irreversible destructive changes – growth of connecting fabric, an atrophy of muscles. Therefore even at elimination of the squeezing factor completely it is impossible to restore motive and sensitive functions.
Taking into account statistics of the reasons leading to development of a sdavleniye of a spinal cord at the heart of prevention of this serious complication the correct diagnostics and treatment of osteochondrosis of a backbone and tumoral diseases is on the first place.