Compression myelopathy
Compression myelopathy is a severe form of complication after suffering from diseases of the nervous system. At the heart of such pathologies is a strong compression of the spinal cord by neoplasms (for example, fragments of collapsed vertebrae in case of injury, or a growing hernia, hematoma or tumor formation).
The content of the article:
Causes of compression myelopathy
Symptoms of compression myelopathy
Diagnosis of compression myelopathy
Treatment of compression myelopathy
Prognosis and prevention
Compression myelopathy
The main symptoms of compression myelopathy include loss of sensitivity and loss of the ability to move. Usually such defects can be traced in the part of the body that is below the site of the lesion. Also, with compression myelopathy, doctors note possible malfunctions in the work of internal organs and their systems.
In order to diagnose this type of disease, CT, X-ray or myelography are usually used. If compression myelopathy is caused by compression of the spinal cord, then treatment is almost always operative.
Compression myelopathy is not considered a separate independent disease, but occurs as a complicated reaction of the body after severe pathologies associated with a violation in the spinal column, as well as in the spinal cord.
The main factors leading to disruption of the functioning of the nerve pathways (in the case of compression of the spinal cord) include:
destruction of the cerebrospinal substance by pathological factors;
compression (or compression) of large vessels, which leads to disruption of the nutrition of nerve tissues, and in some cases to necrosis.
It should be remembered that the longer the duration of compression, the greater the change in the strength of blood flow in the blood vessels.
Causes of compression myelopathy
Regarding the rate of compression of the spinal cord, acute, subacute and chronic myelopathy are distinguished.
Causes of acute compression myelopathy
Development of simultaneous compression
The cause of the acute type of the disease is the sharp development of simultaneous compression of the cerebrospinal substance, which leads to damage to the structures of the spinal cord with many other pronounced symptoms.
It usually takes a couple of hours from the moment of exposure to the agent that caused the initial damage to the moment of occurrence of characteristic clinical signs, although in some cases this process can last up to a minute. The main causes of acute compression myelopathy will be spinal injury or severe hemorrhage under the spinal cord. In addition, the cause of acute compression myelopathy may be an ongoing tumor process or an epidural abscess.
Spinal injuries
The causes of the acute form of the disease can also be spinal injuries, compression fractures with possible displacement of the vertebrae or their fragments. The latter may occur due to severe overload of the spine or when hitting the head (for example, when diving).
Subluxations, dislocations, displacements
Among other common spinal column injuries, subluxations and dislocations are taken into account, as well as characteristic dislocations of the vertebrae. For their reason, the spinal cord is squeezed by bone fragments. In addition, clamps may occur, which is inherent in the spinal canal.
Decreased blood clotting, back injury, incorrect medical actions
If we talk about hemorrhage characteristic of the inner side of the spinal membranes, then it usually occurs in case of back injury, as well as when taking medications that reduce blood clotting (such drugs include warfarin, anticoagulants). Also in medicine, they talk about such a complication, which is caused by medical actions during incorrectly performed anesthesia or incorrectly taken lumbar puncture.
Causes of subacute compression myelopathy
As you know, the spinal cord is localized in the bone canal, which is formed on the basis of holes located in the body of the vertebrae themselves. The spinal cord is surrounded by several membranes at once. Anatomically, the development of compression myelopathy looks like this: blood from a vein (or other damaged vessel) begins to flow into the space between the bone and the solid appearance of the spinal cord. Due to the narrow structure of the spinal canal and the inability of the blood to contract in it, a hematoma is formed, which pushes the spinal cord aside, thereby squeezing it. If such compression lasts up to 2 weeks, then it is called a subacute form of compression. This form can occur even with the rupture of a hernia located between the vertebrae, as well as with the intensive growth of metastases or with a purulent abscess.
A tumor of the spinal cord, which was formed on the basis of vertebral tissues, may not express itself in any way for a long time. But during the cessation of compensation for damage to the nervous tissue, the syndrome of compression of the brain tissue of the subacute type begins to develop. Approximately such a clinical picture unfolds in the case of a purulent abscess maturing under the hard shell.
Approximately the same happens in the case of the formation of purulent abscesses located under the hard shell. This often occurs when a person is ill with tuberculosis or osteomyelitis of the spine. If the purulent congestion increases and reaches a significant size, then the spinal cord begins to squeeze.
If the patient suffers from osteochondrosis of the spine, then compression myelopathy can be caused by squeezing areas of a herniated disc or fibrous rings that protrude. In addition, bone growths called osteophytes can affect the development of the disease. Usually they are formed in a circle from the spinal canal, thereby deforming it over time.
The main feature of ongoing compression myelopathy is the slow manifestation of symptoms. In some cases, the symptoms may appear for several years. In addition, the ability of the spine to compensate for the damage for a long time also leads to the fact that the disease may not be detected in the early stages.
Symptoms of compression myelopathy
Usually, when diagnosing this disease, doctors do not establish the type of compression myelopathy. But in neurology , this disease is usually divided into three types of spinal cord injury:
acute type;
subacute;
and chronic.
The symptoms of compression myelopathy, first of all, will depend on the type of cause that caused the violation. Since the main cause of the disease will be compression of the spinal cord, there are cervical, thoracic and lumbar types of compression. Localization of the lesion is also important in the manifestation of one or another symptom.
Speaking about the anatomy of the spinal cord, it should be said that it is not a homogeneous structure. Usually, motor neurons are concentrated in the anterior part of the spinal cord, which are responsible for the mobility of skeletal muscles. In the back there are very sensitive nerve cells, while on the sides there are centers responsible for the work of internal organs. Regarding which part of the spinal cord is damaged, the patient shows characteristic symptoms.
Acute type
All three forms of myelopathy differ in the rate of development of symptoms, as well as the degree of pronounced functions that were once lost. The acute type of compression of the spinal cord is considered the most severe in its severity. In this case, there is a loss of motor and sensory functions of the body, a sluggish type of paralysis may develop. Usually, sensitivity disappears in the lower extremities. In addition, there is a violation of the functionality of the bladder or rectum. This condition is called spinal shock. After a certain time, a sluggish type of paralysis may develop, which turns into a spastic stage with the manifestation of its characteristic reflexes or convulsions. Joints can become stiff — contracture develops.
Chronic form
Let’s take a closer look at compression in the cervical region. Its chronic form usually begins with the occurrence of blunted pain in the neck muscles or occipital part. It can also manifest itself in the upper part of the chest, in the upper and lower extremities. Approximately in these parts of the body there are violations of sensitive function, which manifests itself in the form of goosebumps or numbness. In the future, weakness in the extremities of a muscular nature may occur. In addition, atrophy and even muscle twitching may occur. In the case of the location of the compression site in the first or second segment, the characteristics of the affected facial nerve may manifest, which is expressed in sensitive failures on the face. The occurrence of symptoms such as unsteady gait and trembling in the hands is also possible.
Another symptom inherent in compression myelopathy is compression in the chest. It should be said that compression in these parts of the spinal cord is extremely rare. They are most often characterized by increased weakness and decreased tone in the lower extremities. Sensitivity in the area of the chest, abdomen or back may also be impaired.
A variety of this disease in the lumbar region manifests itself as pain in the muscles of the thighs, buttocks, and lower legs. In addition to the characteristic pain, there is also a corresponding change in sensitivity in the same areas. As the duration of the traumatic factor itself increases, the patient feels a noticeable weakness in the muscle fibers, decreased muscle tone, atrophy (muscle reduction in volume). Over time, a sluggish type of peripheral paresis may develop in one leg (or both).
Diagnosis of compression myelopathy
The main diagnostic method for studying this type of disease is MRI or CT of the vertebral region. Thanks to the obtained images, you can get a good look at the spine, determine the causes that led to the compression and establish the state of the brain tissue.
In case of inability to perform a tomographic examination and in case of suspicion of a possible fracture of the spine (dislocation of the spine), an X-ray of the spinal column is usually used. It is made specially in three projections.
A lumbar puncture can be performed with further examination of the state of spinal activity.
It is also possible to conduct myelography — such an X-ray technique in which a special contrast is introduced into the subarachnoid space. After the coloring agent is distributed, doctors take several pictures that help to establish at what level compression of the spinal cord was observed.
Treatment of compression myelopathy
Acute and subacute type of myelopathy requires urgent surgical intervention. The purpose of such treatment will be to eliminate the traumatic part of the spinal cord as quickly as possible, which helps to reduce the degree of possible damage to the nerve pathways.
The operation will also be necessary in the case of chronic compression of the spinal cord, especially if this pressure occurred due to an overgrown tumor, regardless of its size or how long the disease itself unfolded.
If we are talking about a chronic type of compression myelopathy, the cause of which was osteochondrosis, the doctor may advise resorting to therapy consisting of two stages. At the first stage, a course of conservative therapy is carried out, which includes the use of anti-inflammatory drugs, vitamins and drugs that can restore cartilage tissue. Appropriate physiotherapy and physical therapy are also carried out. Wearing an orthopedic corset also has a beneficial effect on the patient’s condition.
In case of ineffectiveness of conservative methods or detection of a strong increase in symptoms of a progressive nature, surgical treatment is also prescribed. Depending on what caused this disease, it may be prescribed:
laminectomy;
facetectomy;
removal of a vertebral hernia or bone-type growths;
replacement of the disc with an artificial endoprosthesis;
elimination of a drained cyst;
removal of hematoma;
Urban wedge resection procedure.
It is very important during the treatment and further recovery for patients to adhere to the prescribed spa treatment, which includes a rehabilitation course. Very important importance is given to therapeutic gymnastics, which is prescribed to patients individually and compiled by a doctor.
Prognosis and prevention
Since compression myelopathy is considered the most severe form, first of all, by its symptomatic severity, only timely treatment promises a favorable outcome of this disease. The reason is that in the acute form of pathology, strong changes in muscle tissues and nerves (peripheral) do not have time to develop yet. With timely elimination of the cause that caused the disease, a rapid restoration of conduction (along the spinal cord) can occur, as well as full compensation for previously lost functions.
In the case of a chronic form of compression myelopathy that has developed in muscle fibers, nerves or in the spinal cord, serious destructive processes are observed, characterized by their irreversibility: connective tissue begins to grow and muscle atrophy is observed. Thus, even with the elimination of the compression factor, the restoration of motor and sensory functions will be impossible.
According to statistics, the main preventive measure that can prevent the development of spinal cord compression and possible complications is correct and timely diagnosis with further comprehensive treatment of osteochondrosis or tumor neoplasms.
