Compression of the root in the lumbar spine. Symptoms and treatment of spinal cord compression syndrome Spinal cord compression syndrome

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In the thoracic spine, there are undoubtedly anatomical conditions for compression of the spinal cord and roots by bone and cartilage tissues. The cross-sectional area of the spinal canal here is small compared to the cervical region - 2.3-2.5 cm2 (Ognev B.V., Frauchi V.Kh., 1960). If stenosis of the spinal canal at the lumbar and cervical levels is an abnormal feature, then at the thoracic level this kind of "stenosis" is congenital in all people. Here, it would seem, the chances of compression of the spinal cord by discs are the greatest: there are 12 of them, twice as many as at the cervical or lumbar levels. The spinal cord is fixed by odontoid ligaments, and under the pressure of a large posterior hernia, held by these ligaments, as well as at other levels, it is inevitably deformed. The spinal roots are short here, and this creates the conditions for their tension over the hernia. The blood supply to all segments of the thoracic spinal cord is provided from only the thoracic radiculomedullary artery of Adamkevich and neighboring cervical radiculomedullary arteries. The junction zone is large, the zone of "far fields of irrigation" with blood is another condition for ischemia of the compressed spinal cord. And yet, in the thoracic region, compression and ischemia of the roots and spinal cord are not so common. So, among the operated patients of the Kyiv Institute of Neurosurgery, 14 hernias account for 300 extramedullary tumors of the thoracic level (Brotman M.K., 1969). According to the summary statistics of C. Arseni and F. Nash (1963), vertebrogenic compression thoracic syndromes occur equally often in men and women, usually between the ages of 30 and 60 years, in isolated cases - in younger ones (Peck F, 1957).

First Description herniated discon autopsy was done in 1911 (Midleton G., Teacher J.). In 1950, when examining the spines of 99 corpses, J. Haley and J. Perry found posterior protrusions of the cervical discs 53 times, lumbar - 24, and chest - only 7 times. The results of surgical “verifications” are also consistent with this. The first operation for a herniated thoracic disc was performed in 1922 by W. Adson: it was assumed that a fibrochondroosteoma was removed, which turned out to be a protruding disc tissue during histological examination. Nine years later, the diagnosis of such a hernia was also made preoperatively (Antoni N., 1931), followed by a number of similar publications (Elsberg C, 1931; Pusepp L., 1933; Mixter W., Barr J., 1934; Bourdillon J. , 1934; Hawk W., 1936; Liedberg N.. 1942; Bradford F, Spurting R., 1945; Joung J., 1946; Mailer R., 1951; Swlen J., Karavitis A., 1954; Williams R., 1954; Hulme A., Dott N., 1954; Fineschi G., 1955; HrbekJ., 1955; Kuhlendahl H., Felten H., 1956; Kite W. etal, 1957; Abbot K. etai, 1957; Gzelashvili M.C., 1960 ; Sakamaki, Tsuyi, 1960; Tovi D., Strang R., 1960; ArseniC, Nash F., Wellaner J., 1961; Morita, Matsuschima, 1961; Meirowsky A. et al., 1962; Samotokin B. A., Tsyvkin M. V., 1962; Shulman Kh.M., 1962; Tsivyan Y.L., 1963; Boney, 1964; Van Landingham J., 1964; Irger I.M., Shtulman D.R., 1965; Love J. , Schorne V., 1965; Reeves, Brown, 1968; Brotman M.K., 1969; Shtulman D.R., 1970; Scharfetteer T., Twerdy K., 1977; Singonnas, Karronnis, 1977), on average 0, 5% among those operated on for hernia disk. Among the 5500 patients operated on at the Mayo Clinic for disc herniation, there were only 12 people with this pathology at the thoracic level - 0.2% (Love J., Kiefer E., 1950). Thoracic hernias were more often recorded according to the authors who reported a relatively small number of operated patients: S. Jzumida and AJkeda (1963) - in 1.3%, L. Schonbaur (1952) - in 2%, D.R. Shtulman (1977 ) - in 2%, J.O "Connel (1955) - in 4.3%, V. Logue (1952) - in 4.4%, F. Kroll and E. Reiss (1951) - in 4.8%, G .S. Yumashev and M.E. Furman (1973) - in 6.4%.

The reason for such a "well-being" of the thoracic discs is rightly seen by almost all researchers primarily in the features of the biomechanics of the spine. Accordingly, the disks of this level are relatively flat, the pulpous nuclei are small. The total height of the cervical discs is 40%, and the thoracic discs - only 20% of the height of the corresponding section of the spine. The transition of the spine to the orthograde position most of all affected the mobile cervical and lumbar sections: mobility, micro- and macrotraumatization at the border between the immovable adjacent sections. The thoracic region, firstly, is inactive. Interestingly, in the most mobile lower cervical and lower lumbar discs, hernias occur with the highest frequency: over 90%. A completely different matter is clinically insignificant, without displacement of adjacent vertebrae, spondylographically recorded thoracic osteochondrosis with its anterior horizontally directed bone growths of adjacent vertebral bodies. They are due to another biomechanical factor discussed below. On the other hand, low mobility of the thoracic spine and meninges is attributed to a role in the frequent occurrence of adhesive leptomeningitis (“arachnoiditis”) here with multiple lesions of the spinal cord. According to G. Lombardy and A. Passerini (1964), 40% of spinal arachnoiditis is associated with herniated discs.

The relative rarity of posterior hernias of the thoracic discs is connected, secondly, with the fact that the latter is in a position not of lordosis, but of kyphosis. This causes predominant pressure not on the posterior parts of the disc: the risk of a clinically significant posterior herniation is less here. The anterior sections of the discs in conditions of kyphosis are constantly located between the adjacent bodies of adjacent vertebrae. The discs here are wider horizontally than the bodies of adjacent vertebrae and protrude somewhat beyond their limits in the lateral and especially in the anterior sections. Here they are subjected to pressure, protrusion with the corresponding reactive bone growths. Such chest osteochondrosis is especially frequent in the streets lifting weights. G.Schroter (1958) found similar changes in 92% of the porters examined by him, cervical - in 60%, and lumbar - in 72%.

G.S. Yumashev and M.E. Furman (1973) examined 86 patients with pain in the thoracic spine and radiological signs of thoracic osteochondrosis. Posterior disc prolapses were found only in a few patients.

According to the total literature data, in more than half of the cases, the last three thoracic discs suffer, especially the Tx-xx disc. All authors, following F.Kroll and E.Reiss (1951), explain the indicated localization by the maximum static and dynamic loads on this most mobile part of the spine section. And compression fractures are most often noted at the same lower thoracic level. Still, further observations are required to rule out the factor of the surgeon's subjectivity in selecting patients for surgery: according to some authors, the mesothoracic discs are no less often affected. Thus, according to the literature and own data cited by V. Logue (1952), among 56 operated discs, 45 were at the T|y_x level. due to lower thoracic spinal pathology, was due to an inaccurate diagnosis: myelopathy was caused by compression of the lumbar radiculomedullary artery of Desproges-Gotteron, and not lower thoracic pathology. An analysis of the literature data allows us to allow such an interpretation in relation to individual clinical examples given. As for the first three thoracic discs, they are undoubtedly rarely affected.

The location of a disc herniation or calcified hernia, "osteophyte", across the diameter is median in more than half of the cases, as well as paramedian and lateral. With clearly compressive mechanisms of the disease, the corresponding variants of the clinical picture are associated with the indicated localizations, as well as with the size and shape of the hernia or "osteophyte". They talk about symmetrical paraparesis and parahyperesthesia in median hernias, radicular syndromes in lateral and asymmetric hernias, spinal-radicular disorders in paramedian hernias. However, such direct clinical and anatomical parallels, according to surgical verifications, can be made infrequently. V.Logue (1952), CArseni and F.Nash (1960), I.M. Irger and D.R. Shtulman (1965) and others give a number of examples of discrepancy between the size of the hernial protrusion and the massiveness of the spinal cord lesion. We observed a patient with severe manifestations of TVn-vin osteochondrosis with posterior growths protruding into the spinal canal, with long-term progressive paraparesis and parahypoesthesia. By the time the operation was performed, the spinal cord at the indicated level was ischemic and atrophic, and the membranes were not grossly altered. Apparently, compression of the anterior spinal artery was a matter of the past, and the consequences of this compression were a matter of the present, observed on the operating table - conditions in which the bone-cartilaginous structures of the vertebral segment no longer threatened the thinned spinal cord.

In rare cases, restriction of the volume of the spinal canal and compression of the spinal cord is apparently also possible with juvenile kyphosis by the posterior cartilaginous nodes of the vertebral bodies (anatomical studies by D.G. Rokhlin and A.E. Rubasheva (1936); clinical observations of Blum - cited on topics same authors; Yablon J.C. etai, 1989). E.Lindgren (1941) with the help of contrast radiographic techniques traced the narrowing of the spinal canal at the apex of kyphosis with the expansion of the epidural space above this level in juvenile kyphosis. However, such interpretations of spinal disorders should be evaluated with caution. Not all relevant descriptions of juvenile kyphosis support the thoracic compression nature of these disorders. So, S.S. Bryusova and M.O. Santotsky in 1931 described a 20-year-old patient operated on by N.N. Burdenko. This patient with x-ray picture of juvenile kyphosis underwent Tu-Toush laminectomy due to the onset of a progressive spinal process with spastic paresis of the legs, sensory disorder with T7-T10.

At present, with a retrograde assessment of the observation, the statement about the connection between the spinal process described by the authors and herniated discs at the thoracic level would be unfounded. Only clouding of the arachnoid was found; There was no improvement after the operation. Meanwhile, as follows from the description, 10 years earlier, the patient felt pain in the lower back at the moment of shaking the sheets, and woke up the next morning with paraplegia of the legs and a sensitivity disorder. Subsequently, these disorders regressed. The data obtained in recent decades on compression of the additional radiculomedullary (L5 or Si) artery make it possible to assess the pathology of the spinal cord that followed at the age of 20 as due to compression of the indicated extramedullary artery, and circulatory disorders in the thoracic region as ischemia "at a distance", decompensation of a long-standing pathology in this system. It is unlikely that this decompensation occurred due to compression of the thoracic spinal cord by a disc herniation of this level: the surgeon did not find fixation of the spinal cord, he noted only clouding of the arachnoid. Most likely, under conditions of thoracic kyphosis and usually concomitant lumbar hyperlordosis, decompensation occurred in the area of the old lumbar disc herniation with an impact on the already compressed Desproges-Gotteron radiculomedullary artery. Therefore, the surgical effect at the thoracic level turned out to be ineffective - compression did not occur there.

Negative results of decompressive laminectomy also speak against the direct compression nature of most cases of spinal disorders in deformities (gibbuses, scoliosis) of the thoracic spine (McKenzie K.G., De-war E., 1949). Significance in such cases is given to compression of the anterior spinal artery of the thoracic region by secondary thickening of the membranes, primarily the hard one, on the concave side of the curvature of the spine (Movshovich I.A., 1964; Tsivyan Ya.L., 1966). Perhaps the stretching of the radicular-spinal vessels also matters. Surgeons drew attention to the flattening of the spinal cord, as if stretched by stretched roots, to a decrease in its anterior-posterior size. After crossing the roots, the flattened spinal cord acquires its characteristic rounded shape, and the dura mater becomes less tense, turns pink and begins to pulsate.

With a herniated disc in history, patients often have cervical or lumbar pain. The beginning of the manifestation of a hernia of the thoracic level does not often reveal a direct dependence on physical overstrain or microtrauma. J.Love and V.Shorne (1965), D.R.Shtulman (1970) establish such a relationship as a causal one in an average of 15 protrusions. D.Tovi and R.Strang (1960), V.Logue (1952) revealed an injury in 1/4-1/3 operated, and K.Abbot et al. (1957) - even half. C. Arseni and M. Matestis (1970) revealed radiographic signs of injury only in 2 of 40 operated patients.

Quite often the disease begins with sensation of a numbness or with the phenomena of motive loss. Thus, 5 out of 11 patients operated on by V. Logue (1952) had no pain at all. Sometimes the disease begins with pelvic disorders. A chronically progressive course is possible, including a course without pain manifestations, which can mimic a tumor of the spinal cord. In addition, cordonal pains are also possible, i.e. spreading along the spine due to irritation of the posterior columns of the spinal cord (Bane J., 1923; Lhermitte J., 1924; Langfltt T., Elliot P., 1967). The predominant disturbances of sensitivity are the symptoms of prolapse. On average, half of the observations register hyper-, hypoalgesia and thermohypoalgesia with a clear upper level. In approximately the same percentage, there are also conductive motor disorders - spastic mono- and paraparesis of the legs from the mildest to severe, accompanied by muscle spasms. With a weak severity of conduction movement disorders, they can be detected using tests: 6-8 squats or the same number of tilts or turns of the body (Zagorodny P.I., Zagorodny A.P., 1980). Muscular atrophy was observed in the arms with rare hernias of the first thoracic disc, similar disorders in the legs can be seen more often, they are almost never accompanied by fasciculations.

Sphincter disorders, rarely acting as the debut of the disease, are often encountered later on - in half of the observations (Tovi D., Strang R., 1960; Arseni C, Nash P., 1960, 1963; Irger IM., Shtulman D.R., 1965; Love J., Shorne R., 1965; Arseni C, Martestis M., 1970). According to V. Loge (1952), sphincter disorders join only in advanced cases and are not so common in a pronounced form. This is usually urinary and fecal incontinence or delay and difficulty in the act of urination, lack of sensation of passing urine through the urethra. According to K.Abbot et al. (1957), sphincter disorders in thoracic osteochondrosis are most characteristic of non-radicular compressions in median and paramedian herniated discs Txi-xu- At the same time, along with sphincter disorders, back pain occurs at the level of the lesion and in the legs, sensitivity disorders in the anogenital region.

Particular importance should be attached to the ischemic factor in hernia of this level, where there are conditions for compression of the radiculomedullary artery of Adamkevich. The same, apparently, explains the described rare observations of trophic ulcers of the toes with a hernia of this localization (Arseni C, Nash F., 1963). There are sexual disorders (according to C. Arseni and M. Matestis - in 7.5%): weakening of libido, with damage to the epiconus - weakening of ejaculation, with damage to the cone - weakening of erection. Priapism and satyriasis have also been described. G.S. Yumashev and M.E. Furman (1972) report on patients with hernias of the lower thoracic discs and dysuric phenomena simulating renal colic.

A clear division of compression syndromes into radicular and spinal is not often possible, because. they usually go together. According to our data,radicular compression syndromesoccur among all thoracic vertebrogenic syndromes in 2.3%.

Ya.Yu. Popelyansky
Orthopedic neurology (vertebroneurology)

Description:

Normally, the spinal cord is protected by the bones of the spine, but some diseases are accompanied by its compression and disrupt its normal functions. With very strong compression, all nerve impulses traveling through the spinal cord are blocked, and with less strong compression, only some signals are interrupted. If compression is detected and treatment is started before damage to the nerve pathways has occurred, spinal cord function usually recovers completely.

Causes of spinal cord compression:

Compression can be caused by a fracture of a vertebra, a rupture of one or more intervertebral discs, a hemorrhage, an infection (an abscess in the meninges of the spinal cord), or tumor growth in the spinal cord or spine. An 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 there is a violation of sensitivity in certain areas. Weakness or a decrease in sensation or its complete loss, as a rule, develops below the level of damage. A tumor or infection located directly in the spinal cord or near it can slowly compress the spinal cord, causing pain and tenderness in the area of compression, as well as weakness and sensitivity changes. As the pressure worsens, weakness and pain turn into paralysis and loss of sensation. This usually happens within a few days or weeks. However, if the blood supply to the spinal cord is interrupted, paralysis and loss of sensation can occur within minutes. The most gradual compression of the spinal cord is usually the result of changes in the bones caused by a degenerative lesion of the spine or a very slowly growing tumor. In this case, the person has little pain (or it does not bother at all) and changes in sensitivity (for example, tingling), and weakness progresses over many months.

Diagnostics:

Since nerve cells and 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 bladder and bowel dysfunction. In the place where the spinal cord is damaged, a person often experiences an uncomfortable "tight" sensation. Computed tomography (CT) or magnetic resonance imaging (MRI) usually allows you to determine the place of compression of the spinal cord and find its 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 an X-ray image is used to determine where the filling with contrast is impaired, that is, the deformation of the space is determined. Myelography is more complicated than CT or MRI, and 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 of the intervertebral disc, tumor
bones or spinal cord, accumulation of blood and. Sometimes additional tests are needed. For example, if tests reveal a tumor, a biopsy should be taken to determine if it is cancerous.

Treatment for spinal cord compression:

For treatment appoint:

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 irreversibly damaged. Surgery is often required, although the compression caused by some tumors can be relieved with radiation therapy. Corticosteroids, such as dexamethasone, are usually given to reduce swelling around the spinal cord that aggravates compression. If compression of the spinal cord is associated with an infection, antibiotics should be started immediately. A neurosurgeon drains a pus-filled area of inflammation (abscess), for example, he can suck out pus with a syringe.

Spinal cord compression is a collection of neurological symptoms caused by compression of the spinal cord, which can lead to limb paralysis in a short time. This condition is one of the most dangerous complications caused by cancer (the presence of a tumor in this area or metastasis in the vertebrae). The most common cause of spinal cord compression is lung cancer, kidney and prostate tumors, breast cancer, multiple myeloma. Metastasis in the bones can also provoke a similar condition. So, in 85 percent of cases, two or more vertebrae are affected.
The source of compression of the spinal cord can be located extamedullary (outside the spinal cord) and intramedullary (in the spinal cord or adjacent cavity). There are three types of compression:
1. Acute compression.
2. Subacute compression.
3. Chronic compression.
Regardless of how long and for what reasons such a pathological condition develops, it requires immediate medical intervention, since it is fraught with the development of even more dangerous complications.

Spinal cord compression symptoms

It is quite natural that the first symptom in all patients with compression is acute pain. By its nature and localization, one can judge the location of the compression and its intensity. It may be unstable, but will certainly be present during percussion and palpation. Painful manifestations do not occur due to the compression itself, they are due to damage to the spinal roots or damage to the vertebrae. For example, when the roots of the cervical region are compressed, the pain radiates to the upper limb, and if the function of the lumbar roots is impaired, it radiates to the buttock and lower limb. In addition, with the further development of the compression state, muscle weakness, loss of sensitivity, disruption of the action of reflexes, inadequate functioning of the muscle sphincters of the rectum and urethra may occur.
It is worth remembering that pain in the spine is the first sign of damage not only to the spinal cord, but also to nearby structures. It is felt by almost ninety percent of patients with diseases associated with the anatomical formations of the vertebral region. In order to identify the true cause of pain, the doctor must conduct a thorough comprehensive examination. In 84% of cases, carcinoma is found in such patients, which causes discomfort.

Diagnosis of spinal cord compression

To detect compression, several of the most effective types of diagnostic measures are used. X-rays are used to exclude trauma as a cause of spinal cord compression. In addition, radiography and scanning can detect metastases in the bone tissue of the vertebrae, but do not provide complete information about the state of the spinal cord. MRI is recommended for patients with pronounced manifestations of compression (muscle dysfunction, pain, weakness, lack of sensitivity), since they constitute the first risk group. If there are contraindications to magnetic resonance imaging, high-resolution CT myelography is used. Additional measures are lumbar and cervical puncture. It is also possible to prescribe additional examinations, but they are attributed with great care, since the slightest careless intervention can provoke an attack of the disease. It is also important to explain to the patient's family for which symptoms you need to see a doctor without delay.

Treating spinal cord compression

Spinal cord compression can progress rapidly and cause more dangerous conditions. A patient in such a situation needs to consult an oncologist, a neurosurgeon, a radiologist. Treatment should be started as soon as the cause of the compression is found.
It is impossible to name one most effective method of therapy, since each case is individual and what positively influenced the condition of one patient may not give a result in another. The most commonly used surgical treatment, radiation therapy, treatment with glucocorticoids, X-ray irradiation.
Surgical intervention
Surgical treatment is carried out strictly according to medical indications, since it is a radical method of treatment. Indications for surgery are prolonged and aggravated functional disorders, ineffectiveness of radiation therapy, etc. If the vertebrae are affected, it is safer to remove them than to expose them to some other effect. Therefore, a certain section of the spine is turned off from movement by applying plates to the extreme parts of two or three vertebrae, which are subsequently excised. Thus, the source of pressure on the spinal cord is eliminated. The most commonly used are minimally invasive vertebroplasty and kyphoplasty. Surgical intervention allows you to free the spinal cord as much as possible, and also makes the possibility of tumor recurrence unlikely. In most cases, after excision of the pathological area, patients feel better, and there is a return of functional reflex activity.

Radiation therapy for spinal cord compression

Radiation therapy is a necessary measure if the cause of compression is a tumor or metastases. Indications for this type of treatment:
1. The presence of a radiosensitive tumor (myeloma, neuroblastoma, breast cancer).
2. Contraindications to the operation.
3. Clinical evidence of spinal stability.
4. The presence of numerous foci of compression.
5. Slowly developing process of compression of the medulla spinalis.
Irradiation helps to massively inhibit the growth of secondary cancer cells in adjacent formations. Thus, the timely use of this therapy contributes to the positive dynamics of the course of the disease due to the systemic effect on tumors.
Most often, a course of therapy of medium duration is prescribed. Irradiation is carried out in several sessions, in doses of 2-3 Gy. As a result, the total exposure is 45 Gy. There is another scheme of radiation therapy, when the patient receives an increased dose during the first session, subsequently it is reduced to the usual level. The duration and intensity of treatment depends on the stage of development of a cancerous tumor, the cellular composition, its localization and other characteristics. Previously, an accelerated course of treatment with more intense radiation was used. However, to achieve maximum effectiveness and long-term maintenance of the effect, you need to complete an adequate course of treatment. With regard to prognosis, one should not expect a complete cure in patients with pronounced long-term symptoms of neurological disorders. But with proper treatment and timely intervention, a positive prognosis is almost always expected.
In addition to radiation therapy, radiosurgical methods are used in some situations.

Glucocorticoids

As for medications, the most used are glucocorticoids, or rather, dexamethasone. The introduction of this drug is carried out in an emergency, which is the compression of the spinal cord. Dexamethasone helps to reduce tissue swelling. It is used according to this scheme: first, a loading dose of 20 mg, then 8 mg in the next 10 days, then 4 mg for another two weeks and at the end of the course and subsequently, a maintenance dose of 2 mg is required. There is another option for using the drug (loading dose of 100 mg, followed by 4 mg), but it is much more toxic and its effectiveness is unlikely.
In addition to corticosteroids, other drugs are also prescribed: diuretics that stimulate cerebral circulation, maintain vascular tone, and drugs to maintain renal activity.

The most serious are those that affect the spinal cord. They can lead to very serious, rapidly developing and unpredictable consequences. Symptoms that develop as a result of spinal cord compression are called myelopathy.. What kind of diseases provokes myelopathy?

Spinal cord compression: causes and symptoms

Squeezing can be caused by:

Discogenic dorsopathy:
- big size
- and disk failure
Spinal injuries resulting in injury or swelling
Infectious epidural abscess
Extramedullary and intramedullary tumors
Metastases from primary tumors

KSM types

Spinal cord compression can appear in a matter of hours, taking an acute form, and also go into a subacute or chronic process.

The acute form is often seen in:

comminuted injuries
vertebrae accompanied by displacement of its fragments
spontaneous epidural hematoma

Causes of the subacute form:

Metastatic tumors
Abscesses and hematomas
Intervertebral disc injury

A subacute type of compression may develop within days or weeks.

Chronic compression develops slowly: sometimes this period stretches for many months and even years..
The basis of the emerging pathology are:

Protrusions, hernias, and osteophytes on the background of spinal stenosis
Tumors of the spinal cord and slowly growing formations beyond its redistribution
Pathological connections of arteries and veins (malformations)

Chronic compressions are more common in the lumbosacral region.
In the cervical region, all three types are usually found (chronic, subacute and acute)

In addition to the standard causes, myelopathy in the cervical region can lead to:

Atlas displacement
Fusion of the atlas, the odontoid process of the second cervical vertebra, with the occipital bone
Flattening of the base of the skull and other anomalies of the craniovertebral junction

Symptoms of spinal cord compression

Spinal cord compression is often accompanied by compression of the nerve root and blood vessels, which can lead to:

spinal cord infarction

The first symptom that patients usually notice is pain. However, pain alone is not characteristic of myelopathy:
Pain syndrome occurs only if, along with the membranes or substance of the brain, the spinal nerve root is also subjected to compression

In this case, there are already familiar symptoms of pain and paresthesia, radiating to the limbs:

Upper - when squeezing the roots of the cervical region
Lower - lumbar roots

An obligatory sign is a painful manifestation during palpation and percussion (tapping) of the vertebrae and spinous processes.

Myelopathic symptoms are manifested by sensory, motor and reflex disorders.:

Partial and complete loss of sensitivity
Para- and tetraparesis (paralysis of two or all four limbs)
muscle weakness
Impaired coordination in movements
Pathologies in organs located below the compression site of the spinal cord:
A characteristic sign of myelopathy is atony of the sphincters of the urinary canal and rectum, leading to a loss of control over important physiological acts.
Pyramidal symptoms:
This is the name of the signs of damage to the pyramidal tracts that connect the central and motor neurons of the cerebral cortex and spinal cord.
This results in:
- Pathological hand and foot flexion and extensor reflexes
  For example, one of the reflexes:
  When you strike with a hammer on the palmar or plantar surface, the fingers or toes are bent
- Clonuses:
  Reflex rhythmic muscle contraction as a response to stretching
- Synkinesia:
  - Movements of a healthy limb lead to their arbitrary repetition in a paralyzed
  - Attempts to move in paralyzed limbs lead to increased contractures:
    Flexion - in the hand
    extensor - in the leg

How to Diagnose Spinal Cord Compression

The best way to diagnose KSM is.

If MRI is difficult to do, then CT myelography is used.

CT - myelography is done using lumbar and cervical puncture by introducing a non-ionic low-osmolar iodine-containing drug into the spinal canal

Treatment of KSM

Treatment of SCM is often very difficult. In acute compression resulting from trauma or an epidural abscess, hours can count, during which time every effort should be made to reduce the abscess or swelling.

CSM can be treated conservatively and surgically:

Glucocorticosteroids (mainly dexamethasone) are used for pain relief.
Diuretics, decongestants are prescribed
A radical method is resorted to with the further development of functional disorders and the low effectiveness of conservative treatment.

Operative ways to remove KSM:

Immobilization of the diseased segment with a plate
Removal of the pathological site
Kyphoplasty and vertebroplate
Laminoplasty (surgery to widen the spinal canal)
Discectomy (removal of the affected disc), etc.

Compression treatment for tumors

In the lion's share of cases, compression of the spinal cord occurs due to tumor and metastatic formations of the spine..

In almost 80%, the cause of metastases in the spinal cord is carcinoma. Most often, carcinomas of the breast, prostate, lung and kidney, as well as myeloma, metastasize to the spine.

Scheme of administration of dexamethasone in tumors:

A single dose of 100 mg is urgently administered intravenously
Then every 6 hours - 25 mg

After the therapy, an urgent operation or RT (radiation therapy) is performed.

Indications for surgery

Reasons for surgery are:

Increase in sensory, motor and reflex disorders
Relapse after RT
Spinal instability
Presence of an abscess or hematoma

Indications for radiotherapy

Radiation therapy is given if:

Tumor radiosensitivity (such tumors are breast cancer, myeloma, neuroblastoma)
If surgery is contraindicated
With multiple compression foci
With a slowly developing compression process

An exemplary scheme of radiation therapy is as follows:

15 - 20 sessions are carried out with a dose of 2 - 3 Gy
Total radiation dose — 45 Gy

Cyberknife system

For removal today, the CyberKnife radiosurgical system is used, which, using robotic technologies and software, determines:

Exact position of the tumor
Targeted irradiation of a pathological formation without touching healthy cells

The applied technique is able to remove the compression of the spinal cord and lead, if not to a complete recovery, then to a long-term remission.

Among the various types of dorsopathy, the most serious are those that affect the spinal cord. They can lead to very serious, rapidly developing and unpredictable consequences. Symptoms that develop as a result of spinal cord compression are called myelopathy.. What kind of diseases provokes myelopathy?

Discogenic dorsopathy:
- large dorsal hernias
- sequestered hernias
- disc displacement and prolapse
Spinal injuries resulting in injury or swelling
Infectious epidural abscess
Extramedullary and intramedullary tumors
Metastases from primary tumors