Myelopathy
Myelopathy is a disease of the spinal cord that occurs against the background of other pathological conditions. The term “myelopathy” refers to dystrophic tissue damage of a non-inflammatory nature, while their origin may be different.
The content of the article:
Etiology and pathogenesis of myelopathy
Chronic vertebrogenic myelopathy
Atherosclerotic myelopathy
Epidural myelopathy
Carcinomatous myelopathy
Classification of myelopathy
Symptoms of myelopathy
Diagnosis of myelopathy
Treatment of myelopathy
Prognosis and prevention of myelopathy
Myelopathy
In this regard, almost all representatives of society are at risk. Thus, the primary tumor affecting the spinal cord is characteristic of people of both sexes 30-50 years old, adolescents and young men 15-35 years old are susceptible to injuries, osteoporosis often develops in older women and young people taking steroid hormonal substances. In the case of osteoporosis, myelopathy is formed not because of the disease itself, but because the affected bone is more prone to traumatic damage than healthy bone tissue.
It is believed that the spondylogenic and atherosclerotic type of myelopathy is most characteristic of people with an active lifestyle: athletes and workers engaged in heavy physical labor. This is due to the frequent repetitive injuries that they receive by the nature of their activities during their lives. Therefore, after 55 years, many of them develop myelopathy.
In addition to these categories, potential patients include people with vascular diseases, multiple sclerosis and cancer patients.
Etiology and pathogenesis of myelopathy
In the overwhelming majority of cases of myelopathy, the cervical spine becomes the place of its localization, which occurs as a result of the development of osteochondrosis or spondylosis. In the latter case, we are talking about vertebrogenic cervical myelopathy.
Myelopathy can also develop due to diseases such as congenital stenosis of the spinal canal, craniovertebral anomaly, damage to spinal tissue as a result of injuries and deformities, cirrhosis of the liver, vitamin E and group B deficiency, borreliosis, rheumatoid arthritis, paraneoplastic syndrome. There is myelopathy, which develops as a result of therapeutic measures, which can be chemical and radiation therapy, epidural anesthesia.
There are other types of myelopathy, the causes of which can be atherosclerosis, various inflammations, radiation doses received, osteoporosis, diabetes, etc.
Among the causes of vertebrogenic form, herniated discs, congenital spinal canal stenosis and osteochondrosis are distinguished. Myelopathy of this type develops when the spine regularly experiences loads falling on its upper zones, where the pathology is localized. Acute variant of myelopathy is the result of injuries that patients usually get in car crashes with whiplash. This is a special movement of the head and neck when the car stops abruptly, for example, when colliding with an object. As a rule, this injury happens to an unbuckled driver or passenger in the front seat. The spinal cord in this case is damaged as a result of displacement.
Chronic vertebrogenic myelopathy
Chronic vertebrogenic myelopathy is a consequence of advanced osteochondrosis, due to which the spinal canal narrows and osteophytes form. These bone formations compress tissues and blood vessels, which is why the spinal cord does not receive full nutrition.
Atherosclerotic myelopathy
The atherosclerotic type of myelopathy is one of the complications of cholesterol plaques that interfere with the nutrition of the spinal cord. Plaques occur for genetic reasons, due to heart disease or systemic atherosclerosis.
Epidural myelopathy
Epidural myelopathy is the most dangerous. It is formed after hemorrhage into the spinal canal and, as it develops, disrupts the structure of nervous tissue. Severe bleeding can completely destroy the canal.
Various kinds of neurotropic toxins that reduce the number of nerve cells also cause myelopathy, which is attributed to other types. As a result, the transmission of signals to the brain from individual parts of the body becomes either difficult or impossible at all.
Carcinomatous myelopathy
Cancers cause carcinomatous myelopathy in the process of degeneration of spinal cord tissues. The radiation form of the disease destroys arrays of spinal tissue with ionizing radiation.
Classification of myelopathy
Myelopathy is divided into eight types. The classification is based on the causes that cause changes in the tissues of the spinal cord.
Spondylogenic myelopathy is a consequence of various kinds of degenerative pathologies affecting the spine;
The atherosclerotic type of this disease occurs when cholesterol deposits form on the walls of blood vessels feeding the spinal cord. Most often, this type of myelopathy develops due to systemic atherosclerosis, genetic metabolic disorders, and defects in the cardiovascular system;
Vertebrogenic myelopathy is the result of disorders such as osteochondrosis, stenosis, intervertebral hernia. There are two varieties of this type of myelopathy: chronic — arising in the absence of timely treatment of these diseases, and post—traumatic, also called acute – developing due to injuries. In the first case, the disease occurs as a result of the proliferation of osteophytes, squeezing tissues and blood vessels. In the second — as a consequence of whiplash and displacement of intervertebral discs;
The toxic type is a complication of the poisoning effect on the central nervous system in diseases such as diphtheria and similar diseases;
Radiation. The cause of its development may be radiation therapy carried out in the treatment of malignant neoplasms;
Infectious is a frequently observed pathology provoked by Lyme disease, neurosyphilis, HIV infection, enterovirus infection that affected the body in childhood;
Carcinomatous myelopathy. This pathology is caused by paraneoplastic CNS lesion: oncological process, lymphoma, leukemia, lymphogranulomatosis;
Demyelinating — myelopathy, developing due to demyelinating disorders of the central nervous system of hereditary etiology.
Symptoms of myelopathy
Myelopathy can manifest itself in different ways. There are signs of a general nature and signs that are characteristic exclusively for a specific type of disease. Common symptoms that manifest in any form of myelopathy include:
Paralysis of the arms or legs, depending on the location of the pathology;
Paresis of limbs;
Imbalance in the work of the intestine and bladder;
Numbness in the extremities;
Severe pain in the area of the hearth;
Reduced sensitivity of tissues in the area below the area in which the change is observed.
Ischemic type of myelopathy is a disease that is most often localized in the neck and only in rare cases — in the lumbar region. The course of the disease is long, with the progression of the process. Regardless of the affected area in ischemic myelopathy, there are root and joint pains, numbness, awkwardness of hand and foot movements. There is atrophy and muscle weakness, starting in the limbs closest to the pathology and passing to the rest. In the later stages, disorders of the pelvic organs become pronounced.
The post-traumatic type of this disease is characterized by segmental sensitivity disorders and conduction defects. Segmental disorders in this case are peripheral paresis, accompanied by hyporeflexia and muscle hypotension, and conduction defects — sensitivity below normal and central paresis, which occurs simultaneously with spastic muscle tone and an increased level of reflexes. In addition, there may be: bulbar syndrome, vestibular ataxia, impaired tissue sensitivity in the facial area, complication of urination, incontinence, constipation, infections of the genitourinary system. The presence of certain signs depends on the place where the spinal cord has a lesion.
Radiation myelopathy affects the spinal cord at least six months after the end of radiation therapy. The maximum period in which it can manifest itself is 3 years. The development of the disease occurs slowly with gradual tissue necrosis without changing the cerebrospinal fluid. In rare cases, it may be accompanied by Brown-Sekara syndrome.
Carcinomatous myelopathy is characterized by signs such as necrotic changes in the structure of the spinal cord. Moderate hyperalbuminosis or pleocytosis is found in the composition of the cerebrospinal fluid in patients with this type of disease.
Diagnosis of myelopathy
First of all, to determine the disease, the patient is examined by a neurologist, who, if necessary, prescribes further examination. As a rule, the patient is referred to both laboratory and instrumental studies.
The first ones include:
general and detailed blood analysis;
study of the level of immunoglobulins and inflammatory proteins in the blood;
lumbar puncture;
spinal cord tissue biopsy;
seeding of blood or cerebrospinal fluid.
These tests help to identify an infectious lesion of the spinal cord and its autoimmune disorders. In addition, they provide information about possible circulatory defects in the spinal cord.
Among the instrumental diagnostic methods, computer and magnetic resonance imaging and electromyography are mandatory. CT allows you to visualize the bones of the spinal column, and CT angiography – blood vessels into which a contrast agent is pre—injected.
Using MRI, specialists scan the spinal cord and brain, intervertebral discs and possible tumors in their areas. In the presence of a spinal stroke, it can also be easily considered with the help of this study.
Electromyography provides information about the level of electrical excitation along the peripheral nerves and the entire spinal cord. In some cases, densitometry and radiography are prescribed, which allows to study the spine for the density of its tissues.
Treatment of myelopathy
Despite the fact that myelopathy is a very complex disease, modern medicine has several effective ways to treat it. General therapeutic measures include not only the elimination of the symptoms of myelopathy, but also the fight against the cause of this disease.
Treatment includes a course of B vitamins, antioxidants, vasodilators and neuroprotective drugs necessary to stop further death of nerve cells.
In addition to general measures, patients undergo treatment prescribed for certain forms of myelopathy. So, with a disease caused by osteochondrosis, patients take analgesics and nonsteroidal anti-inflammatory drugs prescribed to them for the period of exacerbation. In the period between these critical conditions, massages, a course of physical therapy and physiotherapy are necessary.
When myelopathy occurs against the background of multiple sclerosis, steroid medications may be prescribed. Antipyretics and antibiotics are used to neutralize infectious infection. Steroids are used, but not always, which depends on a number of features of the patient’s condition.
Compression type of myelopathy often requires surgical intervention, during which a tumor or hernia is removed that interferes with the normal functioning of the spine.
Prognosis and prevention of myelopathy
The patient’s condition in the future is determined by the degree of preservation of the spinal cord substance after the end of treatment. It can be determined only after the blood flow is fully restored, and the compression of tissues has stopped. The sooner doctors manage to eliminate the damaging factor, the more optimistic the prognosis of myelopathy is, therefore, at the first suspicion of its presence, all tests prescribed by a specialist should be passed as soon as possible and a full diagnosis should be made. The doctor makes the first preliminary conclusions based on the results of MRI, but they may take a different form in the field of therapy.
Prevention of myelopathy, as such, does not exist in medicine, since it is a consequence of other diseases. Measures to prevent this pathology include the prevention of infectious infections, cancerous tumors, atherosclerosis, osteochondrosis, intervertebral hernias, diphtheria and other diseases that may cause the development of myelopathy in the spinal cord in the future.
Separately, you need to take care to minimize the likelihood of injuries and severe overloads. People who work physically and athletes need to regularly visit the attending physician for examination and timely detection of signs of pathology of spinal cord tissues. The same applies to people with hereditary demyelinating disorders of the central nervous system. Scientists do not yet know guaranteed protection against myelopathy.
