Myelopathy - description, causes, treatment. What is myelopathy? Causes, symptoms, treatment. What can it lead to and what are the consequences Diagnosis and treatment methods

Quite often, when receiving a medical card, where the diagnosis of myelopathy is recorded, people have no idea what to do, who to hope for, what awaits them. Someone inspires themselves that it is cancer, others see it as a cold. But after all, you need to know everything about your illness in order to learn to live with it.

What kind of disease is myelopathy?

This is how, as a rule, spinal cord problems that arose due to various reasons are called. In general terms, the causes of its development can be called compression, inflammation, trauma, or problems associated with blood circulation in the spinal cord.

If myelopathy is caused by some disease, then its name has a corresponding prefix. For example, ischemic myelopathy, diabetic myelopathy; vascular myelopathy and the like.

In colloquial speech, the term spinal myelopathy is often used.

The ICD10 states that myelopathy includes:

• embolic acute infarction of the spinal cord;
• non-embolic spinal infarction;
• non-pyogenic spinal phlebitis;
• non-pyogenic spinal thrombophlebitis;
• thrombosis of the arteries of the spinal cord;
• swelling of the spinal cord;
• subacute necrotic myelopathy.

• unspecified disease of the spinal cord;
• unspecified spinal cord compression;
• spinal bladder;
• NOS drug and radiation myelopathy.

Now let's look at all this in a more accessible form.

Vertebrogenic myelopathy

This group includes problems of the spinal cord, due to damage to the latter, including its disease, namely:

• compression of the spinal cord by defective contents of the bone canal (bone fragments, hematoma, some inflammatory processes or a displaced disc) or its walls;
• due to damage or compression of the vessels of the spinal region - ischemia;
• injury resulting in spinal cord injury.

If such damage becomes chronic, the signs of the disease may well develop slowly, constantly becoming more complicated or periodically receding, but in the event of a sharp removal of the effect of compression of the spinal cord (decompression) all symptoms can develop at lightning speed.

spinal cord infarction

This disease can occur in almost any of its departments, everything, of course, depends on what exactly is the cause of its development. For example, if a person has arterial hypotension, then those areas that are worst supplied with blood are affected.

At the same time, the limbs can weaken, it becomes very difficult to move them, the muscles become stiff, speech is disturbed. This reduces the sensitivity of the limbs.

Quite often, the causes of a heart attack cannot be found, while it is generally accepted that blood clots in small vessels supplying blood to the spinal cord become the cause. During diagnosis, MRI is used to exclude other types of myelopathy or to confirm their presence.

Vascular myelopathy

This is a chronic disease. And its appearance is provoked by osteochondrosis, a violation of the vascular system, and trauma. Often it leads to a decrease in the sensitivity of all limbs, there are also cases of paralysis.

With vascular myelopathy of the lower extremities, first of all, weakness and fatigue of the muscles of the legs are observed. This leads to insufficient neurotrophic activity of brain cells due to age-related changes, impaired blood supply not only to the central, but also to the peripheral nervous systems. However, osteochondrosis can also be the cause.

Cervical myelopathy of the spine

Myelopathy of the cervical spinal cord is an extremely common disease.

Cervical spondylogenic myelopathy affects the functioning of the spinal cord and its symptom is the so-called stiffness of the muscles of the arms and legs in older people. Under the influence of age-related changes, water leaves the disks, they shrink, and fragmentation occurs.

It all starts in the semi-liquid structure of the spine, where the connective fibers are located, from this the plates of the inner ring move inward, and the outer ring outward. Destruction can occur when the bone itself begins to separate into fibers, gaps form, accumulation of lipofuscin occurs, wrinkling of the disc and its ossification appear.

With cervical cervical vertebrogenic myelopathy, the symptoms are the most complex and lead to very dangerous consequences. But the development of this disease in other parts of the spine can also lead a person to disability.

In this case, the so-called chronic compression of the spinal cord takes place and symptoms of muscle weakness appear not only in the legs, but also in the arms. Moreover, the muscles can begin to atrophy, sometimes contract involuntarily, the sensitivity of the limbs decreases.

Thoracic and thoracic

This type of myelopathy is quite rare, as it is usually caused by a herniated disc in the thoracic spinal cord. But in general, only 1% of intervertebral hernias occur in this part of the spine. And this is due to the structure of the thoracic region.

True, the peculiarities of its structure also interfere with treating it. It is usually cured by surgery. Quite often, myelopathy of the thoracic region is mistaken for tumors, more often for foci of the inflammatory process.

Thoracic myelopathy develops in the thoracic spine, more precisely, it is usually caused by a hernia in the lower part of the thoracic region. Its cause may be an abnormal narrowing of the diameter of the canal in the spine, especially if it is located in an area of ​​risky blood supply.

Lumbar

This type of myelopathy is localized in the lumbar spinal cord and has several different symptoms:

• When the spinal cord is compressed between the 1st lumbar and 10th thoracic vertebrae, epiconus syndrome occurs. With it, radicular pains appear in the lower back, back of the thighs and lower leg. There is some weakness in the legs.
  Paresis of the feet is also observed, the tone of the gluteal muscles decreases, the volumes of the muscles of the foot and lower leg decrease. At the same time, reflexes, such as plantar and Achilles, disappear. There is a degradation of the sensitivity of the posterior outer surface of the foot and lower leg.
• If compression appears at the level of the second lumbar vertebra, then the development of the cone syndrome begins. The pains are not strong, but there are disturbances in the work of the genitourinary system and rectum. Changes in sensitivity in the anogenital region. Rapid onset of bedsores and no anal reflex.
• With compression of the second lumbar root and discs below the vertebrae, a cauda equina syndrome occurs. There are severe excruciating pains in the region of the lower body, radiating to the limbs. Paralysis may appear.

degenerative

Such myelopathy occurs in the syndrome of gradually progressive spinal cord ischemia. It is assumed that its appearance is associated with beriberi, deficiency of vitamins B12 and E.

Compression and compression-ischemic myelopathy

It includes a number of diseases:

• Cervical spondylosis, due to the effects of age-related changes in the spine, worn discs and vertebrae are displaced, causing pain and compression of the spinal cord.
• Narrowing of the spinal canal. It can be either congenital or caused by inflammation of the vertebrae, destruction of the latter, or compression of the spinal disc, which, as a result of destruction, can also provoke the occurrence of a hernia.
• Tumor of the spinal cord.
• Purulent inflammation located between the wall of the bone and the spinal cord itself.
• Hemorrhage in the spinal cord, in which extremely sharp pains are felt in the back. It can happen with a small physical injury of the spine, puncture of the spinal cord, with various existing blood diseases.
• Internal bleeding that soaks the spinal cord with blood.
• Acute protrusion of the intervertebral disc, or, in other words, indentation of the disc into the spinal canal.
• Acute injury with a fracture of the back or displacement of the vertebrae.

Spondylogenic

A condition that progresses as a result of chronic injury to the spinal cord and, of course, its roots with a constant forced position of the head is called spondylogenic cervical myelopathy.

Most often, it leads to a change in the gait of a person with age. The manifestation of this type of myelopathy worsens the condition of patients with cerebral palsy.

Dyscirculatory myelopathy

It is chronic. At the same time, the muscles of the limbs weaken, involuntary muscle contractions may appear, sensitivity decreases, and a disorder of the pelvic organs occurs.

Sometimes this type of myelopathy is confused with meningomyelitis, spinal cord tumor, myelopolyradiculoneuropathy, amyotrophic lateral sclerosis, syringomyelia, funicular myelosis.

Discogenic

Often referred to as vertebral myelopathy. It is worth noting that it can occur as one of the complications of disc herniation due to the long process of degeneration and is a completely independent disease.

Solid disc herniations appear, which in reality are growing bony bodies of the vertebrae. They compress the spinal cord and spinal arteries.

Focal and secondary myelopathy

May be a consequence of external exposure or the result of ingestion of radioactive substances. It is combined with hair loss (foci), skin inflammation, in which the smallest bubbles with fluid form, or skin ulcers, loosening of the skin, scarring of the meninges, thinning of bones, bone fragility.

Its symptoms depend only on the location of the lesion. As a result, there is numbness of the limbs, muscle weakness (especially in the legs) and dysfunction of the pelvic organs of different depths.

Post-traumatic

Post-traumatic myelopathy, as can be seen from the very designation of the disease, develops as a result of spinal cord injuries. This spinal syndrome has the following symptoms:

• paralysis;
• pelvic disorders;
• sensitivity disorders.

All these symptoms remain with the patient throughout the rest of his life.

Chronic myelopathy

The reasons for its occurrence may be:

• subacute combined degeneration of the spinal cord. There is often a lack of vitamin B12 and anemia occurs. The disease leads to damage to the corresponding fibers of the spinal cord, which causes a partial loss of control over movements, they become awkward. Sometimes the optic nerve can be affected. And this, of course, leads to loss of vision;
• syringomyelia, that is, the appearance of small cavities in the spinal cord;
• multiple sclerosis;
• poliomyelitis, which usually leads to paralysis;
• cervical spondylosis, disc protrusion (see above);
• other diseases of the spine, as well as the entire spinal cord;
• syphilis;
• infectious diseases that can affect the spinal cord;
• cirrhosis of the liver.

Virtually all types of myelopathy can be classified as chronic myelopathy, but only if their development does not progress. In the opposite case, we were faced with progressive myelopathy.

progressive

This is the designation of myelopathy resulting from the Brown-Séquard syndrome, which may well affect half of the transverse section of the spinal cord and cause paralysis or weakening of the muscles of the affected side of the body, and then in a couple of months, or even weeks, brings a person to muscle weakness and a decrease in the sensitivity of the lower body parts.

Usually the disease progresses very quickly, but sometimes its development is extended for several years.

Myelopathy Symptoms

First symptoms:

• temperature increase up to 39°;
• chills;
• general malaise.

Neurological symptoms do not appear immediately. Among the first, mild pains with a radicular character, as well as weakness of all limbs, may well appear. Their location depends on where the point of inflammation is located.

After a few days, disorders of the musculoskeletal system, sensitivity appear and rapidly progress, dysfunction of the pelvic organs appears. From time to time, uncontrolled muscle contractions may occur.

Diagnostics

When examining patients, use:

• for visualization of the spinal cord and brain, tumors and intervertebral discs;
• computed x-ray tomography for better visualization of the bones of the spine, as well as examination of the circulatory system;
• electromyography makes it possible to assess the passage of electrical excitation through the spinal cord, as well as through peripheral nerves;
• a blood test that makes it possible to determine an infectious disease, diagnose a metabolic or autoimmune disease of the spinal cord, and also provides information about changes in blood viscosity.

Treatment of the disease

Treatment of spinal myelopathy is absolutely dependent on the causes that affected the state of health. At the same time, the treatment of post-traumatic myelopathy, including the lumbar, is carried out with anesthesia and procedures for the correction of the spine.

The procedures themselves consist in stretching and fixing the patient's body in a motionless state. This ensures proper fusion of the spine.

It includes a number of necessary procedures:

• visiting a massage parlor or massage sessions at home;
• therapeutic exercises;
• procedures in the physiotherapy room.

If the vertebrae are split or crushed, then an operation is performed. With the timely start of treatment, the problem with myelopathy can be completely eliminated.

Myelopathy due to infectious diseases requires a slightly different approach, and the healing process itself is delayed for a longer period. All treatment is aimed at fighting the infection and the main drugs in this case are strong antibiotics.

In order for the patient to feel better and his condition to stabilize, a number of antipyretic drugs and drugs are used to help cope with inflammation. The course of treatment with medications can only be prescribed by the attending physician.

Cervical myelopathy has a range of treatments to speed recovery. If you can do without the intervention of a surgeon, then apply:

• neck collar that gently limits all movements of the cervical vertebrae, allowing the neck to rest. However, its long-term use can lead to atrophy of the neck muscles, so its long-term use is not desirable;
• traction of the spine in the cervical region by methods of physiotherapy;
• exercises that strengthen the muscles of the neck.
• Traditional medicine is also widely used, which consists in a medical technique. It uses:
  • drugs of the non-steroidal group of anti-inflammatory substances act as the main course. These include ortofen, ibuprofen, pyrosicam, etc. Some drugs can be in the form of tablets, others are taken intramuscularly;
  • drugs that relieve spasms in the muscles of the neck, called muscle relaxants: pipecuronium, mivacurium, pancuronium and others;
  • drugs whose action helps to relieve muscle pain: gabapentin and other drugs in this group;
  • drugs that belong to the group of steroid medicines and are used locally, that is, an injection is made directly into the area of ​​\u200b\u200bmuscle pain, directly to the one on which the compression is performed to alleviate the condition.

Compression myelopathy almost always requires surgery, because in such cases it is necessary to remove the tumor or intervertebral hernia. Unfortunately, there is no other way to treat such disorders in medicine.

Myelopathy, the appearance of which provoked arthritis, is still the most problematic type. It is almost impossible to completely cure it, so special attention is paid to the symptoms. Usually anesthesia is done and arthritis is treated, which does not eliminate the disease itself, but only stops the process of its development.

Drugs have appeared on the modern drug market that improve the condition of the spinal cord in myelopathy. These are Sirdalurd, Tolperizon, Mydocalm, etc.

The video shows orthotics (special prosthetics) for myelopathy:

Forecast

How much treatment will help, and what results to expect depends largely on how damaged the tissues of the spinal cord are and what factors led the patient to this condition. At least some clarity appears only after all the causes of the disease are completely eliminated.

Myelopathy, triggered by fractures, minor injuries or infection, can be completely cured, and over time the person almost forgets about the existence of this disease.

But the situation is quite different with chronic types of myelopathy. Long-term treatment, most likely, will alleviate the suffering of the patient for a short time, and it is very difficult to talk about a complete cure in such cases.

There are cases when it is not possible to stop the development of the disease, as a result of which the patient may become disabled.

Myelopathy in children

The most common type of myelopathy in children is acute enteroviral transistor myelopathy. In many children, it begins with an increase in temperature, although this is not always the case. Quite often, this process is similar to the common cold and does not arouse suspicion among others. Over time, weakness in the muscles appears, lameness appears.

As soon as you see the first signs of an emerging disease, you need to call a doctor, because the sooner the disease is diagnosed, the higher the chance of curing it. Like other types of myelopathy, this type can also lead to disability in the child.

An extremely common cause of childhood myelopathy, other than those listed above, is a lack of vitamin B12. At the same time, it can develop in children with cerebral palsy syndrome, as well as manifest itself as atrophy of the spinal muscles.

A few more words for you
Whatever the diagnosis, one must always remember that in optimistic people, all physical ailments do not linger for a long time. Yes, myelopathy is not an easy disease and if you have been diagnosed with this disease, you will have to undergo complex treatment. But remember, in order to get rid of the disease, treatment must be started immediately. Smile more often, think about the good, and then all adversity will leave you.

Dynamics of the results of treatment of myelopathy and congenital dislocation of the hip in Israel:
http://www.youtube.com/watch?v=ecsbV9W9lO8

Definition

Cervical discogenic myelopathy is a relatively common pathology of the spinal cord, especially in the elderly, it is based on vascular disorders.

Causes

With the help of histological studies in discogenic myelopathy, fibrohyalinosis of small intramedullary vessels is often detected in the spinal cord, which is also constantly observed in atherosclerotic myelopathy. In addition, with discogenic myelopathy, the narrowness of the spinal canal is found. With direct compression of the spinal hernia of the intervertebral disc (less common), a picture of a pseudotumor occurs. Cervical myelopathy is much more common than thoracic or lumbar myelopathy.

Symptoms

Clinically, with cervical discogenic myelopathy, spastic-atrophic paresis of the hands and spastic paresis of notes, spontaneous nystagmus, cerebellar discoordination, increased mandibular reflexes, facial hyperesthesia, tongue fibrillation are found.

Attention should be paid to the damage to the muscles of the trunk and legs, which is observed when the pathological process is localized in the region of the segments of the spinal cord located below the disc osteophyte node, which occurs due to irritation of the sensitive and spinal conductors and often disappears after surgery (decompression of the cervical capal). With cervical osteochondrosis, the posterior columns of the spinal cord are affected, as a result of which long-term hypesthesia and paresthesia appear, resembling a picture of polyneuritis.

Among other complications of osteochondrosis of the cervical spine, there is a violation of spinal circulation.

Spinal ischemia is characterized by an acute onset with the development of tetralgia, lower paraplegia, dysfunction of the pelvic organs. Often acute ischemic spinal disorder occurs after physical stress and spinal injury.

Diagnostician

An otoneurological examination of patients with cervical discogenic myelopathy reveals vestibular disorders.

The presence and severity of myelopathy can be assessed using transcranial magnetic stimulation (TMS), a neurophysiological method that measures the time it takes for neuronal firing to traverse pyramidal regions, starting in the cerebral cortex and ending in the anterior cornea of ​​the cervical, thoracic, and lumbar section of the spinal cord.

Prevention

The only effective treatment for myelopathy is surgical decompression of the spinal canal. The doctor also prescribes conservative treatment for the patient - NSAIDs, activity changes and exercises that will help relieve pain.

Myelopathy in the ICD classification:

Online doctor's consultation

Specialization: Neurologist

Rudolf: 01/23/2013
Hello! About two years ago, I started to choke. He was constantly yawning for air. Couldn't breathe. Has addressed to the doctor. I had an ultrasound of the heart, an x-ray of the lungs. Everything was normal. They said that I have vegetative-vascular dystonia. After a while, everything went away for me, and did not bother me for more than a year. But then the suffocation returned, the heart began to beat strongly, the hands and feet sweated. I quickly got tired and felt overwhelmed. I went to the same doctor, he checked the thyroid gland, made a daily ECG - everything is fine. The doctor prescribed Riboxin and Panangin. Then I got better again. But another month passed, and the muscles began to twitch, there was ringing in the ears, fog in the head. What could it be? Tell me please.

Myelopathy is a generalized name for diseases of the spinal cord, which is used in neurology.

The diseases included in the group called myelopathy have various causes of origin, but almost all pathologies have a chronic course of the disease.

What is myelopathy?

Myelopathy is a pathology that includes changes in the dystrophic nature of the spinal cord, without being tied to the etiology of the pathology.

These are chronic types, as well as subacute types of a degenerative process in the spinal cord, which occurred through disturbances in the blood flow system, as well as in the metabolic processes of the spinal types of segments.

Quite often, myelopathy is a complicated form of degenerative or dystrophic pathologies of the human spine and:

• Vascular systems;
• infectious diseases;
• Effect on the body of toxins;
• Dismetabolic changes;
• Spinal injury.

Each time with a specified diagnosis, it is necessary to indicate the complicated form of which pathology - ischemic type myelopathy, compression myelopathy.

ICD-10 code

According to the international classification of diseases of the tenth revision of ICD-10 - this pathology belongs to the class "Myelopathy and other diseases of the nervous system" and has the code:

• G0 - Autonomic neuropathy in endocrine and metabolic diseases;
• G2 - pathology myelopathy in other diseases;
• M50.0 - myelopathy of intervertebral discs;
• M47.0 - myelopathy disease in spondylosis;
• D0 - myelopathy disease, with tumor lesions;
• G1 - vascular myelopathy;
• G2 - compression of the spinal cord;
• G8 - other unspecified diseases of the spinal cord;
• G9 - pathology of the spinal cord, unspecified.

Causes of myelopathy

With the same etiology, different types of myelopathy occur, just as a certain type of myelopathy can be triggered by different etiologies.

The reason for the compression that develops:

• From the formation of an intervertebral hernia, with displacement of discs between the vertebrae, with pathology of osteochondrosis - discogenic etiology;
• Damage to the vertebrae during surgery, or after injury;
• Sliding of intervertebral discs and vertebrae - spondylolisthesis occurs, which leads to myelopathy of the lumbar spine;
• As a secondary pathology of adhesive disease;
• With neoplasms in the spinal organ.

Violation of blood flow in the spinal organ. This pathology is provoked by several reasons, including impaired blood flow in the spinal cord.

Dyscirculatory myelopathy leads to a chronic type of insufficiency of the spinal blood supply:

• Aneurysm of the spinal vessels and pathological changes in them;
• The disease is atherosclerosis;
• Embolism of the spinal arteries;
• Thrombosis disease;
• Stagnation of venous blood (find out why it is than arterial blood), which develops as a result of cardiac type insufficiency, or pulmonary insufficiency;
• Squeezing of the veins in the neck, as well as squeezing in other parts of the back, is a venous cause;
• Spinal stroke.

Inflammation that is localized in the spinal organ, which can be the etiology of back injury, infectious diseases, as well as:

• Lung disease - tuberculosis;
• Pathology myelitis;
• Spinal arachnoiditis;
• Bechterew's disease.

A metabolic disorder in the body that develops on the basis of hyperglycemia in diabetes mellitus is a diabetic form of the disease.

In addition to these causes, myelopathy has many different causes that are not even fully understood yet. The risk group for this disease is very young people who are a little over 15 years old, as well as people who are over 50 years old.

Who is at risk?

• Active boys and girls who do not pay attention to the risk of spinal injury;
• Patients who have problems in the vascular system;
• cancer patients;
• Older women at risk of developing osteoporosis;
• Patients with the development of the disease multiple sclerosis;
• Athletes of power sports;
• People with hard work;
• With a sedentary lifestyle.

Classification of disorders in the spinal cord

The disease Myelopathy is classified into several types, due to the occurrence of:

• Vertebrogenic myelopathy. This type of myelopathy is the most common among patients. The development of this type of disease is associated with trauma, or compression of the nerve endings of the spinal cord. There are 2 types of vertebrogenic myelopathy: an acute form and a chronic type of pathology. The acute form of myelopathy develops after a serious injury with a displacement of the vertebral discs, or a fracture of the spine. The chronic form is a form of slow development of a disorder in the spinal cord, as a consequence of the pathology of osteochondrosis;
• Atherosclerotic form of pathology. This type provokes the disease atherosclerosis, which, with cholesterol plaques, disrupts blood flow to the spinal cord and causes deviations in its work. Also, the causes of atherosclerotic myelopathy can be acquired heart defects, as well as metabolic disorders, which caused an increased index of cholesterol in the blood;
• Vascular form of pathology. This type of disease is provoked by a violation in the work of the blood flow system in the body, as well as the state of the arteries and veins. The vascular form is common in the thoracic spine and the type is radiculomyelopathy;
• epidural disease. This form is the most dangerous, because it is a consequence of hemorrhage in the spinal cord, which most often leads to its defeat and destruction. The biological fluid (blood) in the spinal type of stroke penetrates into the canal of the brain (spinal), which causes irreversible destructive processes in it;
• Compression view caused by pressure on the spinal cord.

There are also divisions of myelopathy according to the following criteria:

• Degenerative type of disorder - causes spinal ischemia, as well as a lack of nutrients for the brain in the body (myeloischemia);
• Infectious form, provoked by an infection that affects the spinal organ;
• The focal form is formed as a result of exposure to the brain of radiation elements.

Ischemic form of myelopathy

The spinal arteries are rarely exposed to the growth of atherosclerotic plaques. Most often this type of lesion undergoes cerebral vessels. Cerebral ischemia often occurs in people who are older than 60 calendar years.

The cells of motor neurons, which are located in the anterior part of the horns of the spinal canal, are most sensitive to myeloischemia. For this reason, the motor system is affected, with paresis of the arms and legs, which, in terms of symptoms, are similar to ALS syndrome.

A clear diagnosis can be obtained with a comprehensive examination in neurology.

Post-traumatic form of myelopathy

Myelopathic syndrome develops this form of pathology after a back injury, as well as in the post-traumatic rehabilitation period.

The symptoms of this type of syndrome are quite similar to syringomyelia, where such symptoms appear:

• elevated temperature;
• Pain in the muscles;
• Soreness of the joints.

Post-traumatic myelopathy is a complication after an injury and is irreversibly destructive.

Pathology has a progressive form and is complicated by the presence of an infection of the genitourinary system in the body:

• infectious cystitis;
• Disease urethritis;
• Infectious inflammation of the kidneys - pyelonephritis;
• Sepsis.

Radiation-type myelopathy

The radiation type of myelopathy is observed in the cervical segment in patients who have treated laryngeal cancer with radiation therapy. In the chest, it is observed in patients who have undergone radioactive irradiation with oncological neoplasms of the mediastinum.

This type of disease develops from 6 calendar months to 3 calendar years. The greatest peak of development occurs a year after irradiation. In such a situation, differential diagnosis is necessary to establish a diagnosis in order to exclude metastasis to the spinal cord.

Cervical myelopathy does not have a rapid progress in development, and is caused by necrosis of the cells of the spinal tissues.

With a necrotic lesion, Sekar-Brown syndrome manifests itself. In the cerebrospinal fluid (cerebrospinal fluid), no damage occurs.

Symptoms of the development of all types of myelopathy

The symptomatology of all types of development of this disease is similar, but there are individual differences in the signs of each section of the spine.

Common symptoms include:

• Reduced sensitivity of the skin in the affected part of the back;
• Muscular general weakness;
• Difficulty in movements;
• Paralysis of muscles.

Cervical disease, symptoms:

• Severe pain in the neck area;
• Pain in the back of the head;
• Pain between two shoulder blades;
• Muscle spasms;
• Weakness of the hands;
• Hand tremor;
• Numbness of the skin in the arms and neck.

Symptoms of myelopathy of the chest level:

• Heart pain, as in a heart attack;
• It is impossible to work with your hands due to severe weakness, which provokes disability;
• When bending over, the pain increases and radiates to the ribs;
• The sensitivity of the chest part of the body disappears;
• Muscle spasms in the arms;
• Spasms in the region of the heart organ;
• Hand tremor.

Lumbar symptoms:

• severe lower back pain;
• Numbness of the skin of the lower extremities;
• Weakness of the legs;
• Paralysis of the legs, myelopolyneuropathy develops;
• Violation in the functionality of the intestine;
• Deviation in the function of the bladder;
• The pain radiates to the internal vital organs.

Diagnostics

In order to establish the correct diagnosis of myelopathy and determine its exact type, the patient needs to undergo a series of clinical laboratory tests, as well as the study of the pathology using an instrumental technique:

• The method of computed tomography of the spinal cord (CT);
• MRI (magnetic resonance imaging) of spinal cells;
• Fluorography method to exclude inflammatory processes in the lungs (pneumonia);
• X-ray diagnostic technique;
• Cardiogram of the cardiac organ to exclude myocardial infarction;
• Electromyography method;
• Medica densitometry of the spinal cord.

Clinical laboratory studies of pathology:

• General analyzes - urine and blood;
• Biochemical clinical analysis of blood composition for the determination of immunoglobulins;
• CSF culture (cerebrospinal biological fluid);
• Puncture of spinal cells;
• Biopsy of bone tissue cells, as well as muscle tissue cells.

Treatment of the pathology of spinal cord injury

Therapy for spinal myelopathy is carried out in accordance with the type of disease, as well as the degree of its development. Is myelopathy curable?

The treatment of this disease is carried out by a conservative medical method, as well as by a surgical surgical method.

First of all, you need:

• Stop an attack of myelopathy, in which severe pain is felt. Analgesics are used. Especially painful is an attack of the vertebrogenic type of pathology, which provoked osteochondrosis;
• Ensure stability after an attack.

To ensure stability in myelopathy, the following groups of drugs are prescribed:

• Non-steroidal drugs;
• A group of muscle relaxants to relieve muscle spasms;
• Analgesics;
• Injectable steroids.

The surgical treatment of pathology is approached in a balanced way and is used if conservative treatment does not last a positive effect. The exception is the tumor, which must be removed immediately.

These medicines include:

• Means of the group of neuroprotectors;
• Medications metabolites;
• B group vitamins.

Physiotherapy is also used in the treatment:

• diathermy method;
• Method of galvanization;
• Method of treatment paraffin therapy;
• Therapeutic massage to prevent atrophy of muscle tissue;
• Electrophoresis method;
• Reflexology with a rehabilitation specialist;
• Water and mud treatment;
• Electrical stimulation of muscle tissue.

Consequences of spinal myelopathy

The main consequences of myelopathy:

• Frequent phantom pain;
• Paralysis;
• Complete absence of reflexes;
• Damage to the bladder and intestines.

Prevention

Due to the fact that myelopathy does not have a single development etiology, it is therefore impossible to paint individual rules for prevention.

There are common methods:

• Food culture. For the full functioning of all departments of onanism, he needs the necessary amount of vitamins, as well as trace elements and minerals. Food with a predominance of carbohydrates leads to obesity and a high index of cholesterol in the blood;
• adequate activity. For all parts of the spine, adequate activity is required, which is provided by physical culture and sports;
• Don't overexert your body. Do not lift heavy weights that lead to injury to the intervertebral discs;
• Constantly monitor your gait and posture;
• Timely treatment of infection in the body, and prevent the transition of the disease to a chronic level;
• Give up alcohol and nicotine addiction;
• Timely undergo a diagnosis of the spine;
• Constantly monitor blood glucose levels;
• Avoid back injury
• In case of violation in metabolism, contact a specialized specialist;
• Avoid intoxication of the body with plant poisons and heavy metals.

Prognosis for life with myelopathy

The disease myelopathy has a favorable prognosis for life, only in the case of timely diagnosis of the disease and its complex treatment.

The ischemic type of myelopathy quite often has a progressive nature of the disease, and repeated medical courses of vascular treatment can stabilize the course of the disease. The prognosis is more favorable.

The prognosis for life of cervical myelopathy depends on timely treatment.

The post-traumatic type of pathology is stable and is not a rapidly progressive disease.

Demyelinating myelopathy progresses rapidly, as well as its carcinomatous type - the prognosis for life is unfavorable.

The radiation form of the disease is caused by neoplasms of an oncological nature - the prognosis is unfavorable.

With oncology, a high risk of metastasis - the prognosis of myelopathy is unfavorable.

With severe trauma with extensive bleeding, the prognosis for life is also unfavorable.

Chronic or acutely developing softening of the tissues of the spinal cord, resulting from a violation of its blood circulation. It is manifested by motor and sensory disorders corresponding to the level of the spinal lesion, the nature of which determines the topography of the softening zone. Vascular myelopathy is established according to the history, neurological status, MRI of the spine, spinal angiography and EFI of the neuromuscular system. Treatment includes vascular, decongestant, antioxidant, and neuroprotective therapies. According to the indications, it is possible to carry out surgical interventions on the vessels or structures of the spinal column.

General information

The second group consists of pathological changes occurring in the vessels themselves: aneurysm and hypoplasia of the spinal vessels, atherosclerosis, systemic vasculitis, thrombosis, embolism, periarteritis nodosa, syphilitic arteritis, etc. Congenital malformations of the cardiovascular system (for example, coarctation of the aorta) contribute to the occurrence of vascular disorders and features of hemodynamics (hypotension).

The third group of factors is manipulations and surgical interventions, the complication of which can be vascular myelopathy. Among them are epidural blockade, spinal anesthesia, interventions on the aorta (clipping, aneurysm resection, plastic surgery), operations in the abdominal and thoracic cavities.

As a result of exposure to one of the above factors, ischemia occurs in the area of ​​the spinal cord - insufficient blood supply. The consequence of a violation of the spinal circulation is oxygen starvation and insufficiency of the metabolism of the nervous tissue. Initially, this leads to functional disorders that are reversible. Then, if ischemia is not eliminated, then irreversible necrotic changes occur - softening of the substance of the spinal cord, which leads to a permanent loss of its function. At the same time, the state of hemodynamics and the development of collateral circulation play an important role. The further from the spinal cord the vascular lesion is localized and the slower the development of the pathological process, the more conditions and time for the formation of an alternative collateral blood supply to the ischemic area.

Symptoms of Vascular Myelopathy

Acute vascular myelopathy

Acute forms of myelopathy of vascular origin are sudden. Manifest flaccid (peripheral) paraplegia or tetraplegia with sensory disorders such as syringomyelia and sphincter disorders. May be accompanied by acute pain syndrome. Pain is localized in the spine, sometimes radiating along the roots. In some cases, acute vascular myelopathy begins with manifestations of transient spinal ischemia: paresthesias, transient motor and pelvic disorders.

Treatment of vascular myelopathy

As a rule, vascular myelopathy is treated in a hospital setting. Acute vascular myelopathy requires urgent treatment; at the same time, the earlier it is possible to restore adequate spinal circulation and stop necrotic changes in spinal tissues, the less pronounced in the future are the residual effects of vascular catastrophe. The first priority in the treatment of vascular myelopathy of compression genesis is to eliminate the source of compression. For this purpose, it is possible to remove tumors of the spinal cord, plastic surgery of the aorta with its aneurysm, elimination of subluxation of the vertebrae with subsequent fixation of the spine, removal of a herniated disc (discectomy), etc. Surgical interventions, depending on their type, are performed by neurosurgeons, oncologists, orthopedists or vascular surgeons .

Drug therapy is reduced to the complex appointment of vasoactive drugs. In order to improve collateral blood flow, eufillin, bendazol, nicotinic acid, papaverine are prescribed; to maintain spinal circulation - vinpocetine; to stimulate venous outflow - horse chestnut extract, troxerutin; to improve microcirculation - pentoxifylline, dipyridamole; with a decongestant purpose - furosemide; to reduce hypoxia of neurocytes - meldonium, hopantenic acid. Hematomyelia is an indication for the appointment of anticoagulants (calcium nadroparin, phenindione, heparin).

bedsores, congestive pneumonia, cystitis, pyelonephritis, sepsis. In acute myelopathy, a small lesion and timely therapeutic measures can result in 100% restoration of lost functions. The most active reduction of neurological deficit occurs in the first 6 months, the final recovery may take several years.

Preventive measures include the timely treatment of vascular diseases and anomalies, the prevention of spinal injuries and degenerative processes in the structures of the spinal column. Preventive measures also include accurate and technically correct performance of spinal anesthesia and surgical procedures.

In the human body, the spinal cord is an integral part of the central nervous system. This organ, located in the spinal canal, is responsible for a lot of functions, the work of vital systems. Diseases affecting the spinal cord are a serious danger, one of the most common pathologies is myelopathy.

In medical terminology, the words myelopathy of the spinal cord means a whole set of various lesions of the spinal cord. This concept combines a number of pathological processes that are accompanied by dystrophic changes.
Myelopathy is not an independent pathology. The occurrence of the disease is preceded by a number of factors, which determine which nosological form is diagnosed in a person.
In other words, myelopathy, that is, damage to the substance of the spinal cord, can be caused by injuries and all kinds of diseases, on which the name of the subsequent form of pathology depends. For clarity of thought, consider simple examples:

• Ischemic - develops due to ischemia of any part of the spinal cord, that is, we are talking about a violation of blood flow.
• Diabetic - occurs on the background of diabetes mellitus.
• Alcoholic - its harbingers are disorders caused by severe dependence on alcohol.

Many more examples can be given by analogy. The main idea is that it is necessary to accurately determine the form of myelopathy, because the treatment being built will depend on this.
The pathological process can be subacute or chronic, but in addition to this fact and the mentioned forms of the disease, it also has more types that differ in the nature of occurrence, the nature of lesions of the spinal cord tissues, symptoms and methods of treatment.

Causes

As mentioned earlier, the disease develops against the background of a huge number of concomitant factors. The main causes of the pathological process are other diseases or injuries of the spine:

• vascular atherosclerosis;
• osteoporosis;
• as a result of injury;
• infectious diseases;
• oncology (tumors of the spinal cord);
• circulatory disorders (ischemia, hemorrhage, etc.);
• physiological changes in the spine (scoliosis and others);
• exposure to radiation.

Given such a variety of reasons that can serve as an impetus for the development of myelopathy, we can say that both milled people and the elderly are susceptible to the disease.
In addition to the causes of the development of the pathological process, it is also possible to identify factors that predispose to the onset of the disease:

• an active lifestyle with an increased risk of injury;
• diseases of the cardiovascular system of various etiologies;
• oncological pathologies in the body with the risk of metastasis;
• professional sports;
• advanced age;
• spinal problems can also develop due to a sedentary lifestyle and a host of other less common factors.

Classification

According to ICD 10, the class of myelopathy diseases includes a whole group of pathological processes in which damage to the spinal cord occurs against the background of other diseases.
In the international classification of myelopathy, the code according to ICD 10 is assigned - G95.9 (unspecified disease of the spinal cord).
As for a more detailed classification of the pathological process, as mentioned earlier, spinal myelopathy is divided into many separate types. In each case, we are talking about a variety of pathology, with its own causes of development, symptoms and other conventions. To create a complete picture of the disease, consider each type of pathological process separately.

Vertebrogenic

Vertebrogenic myelopathy develops due to damage to the spinal cord of a different nature and severity. The main reason is all kinds of functional lesions of the spine, both congenital and acquired.
In most cases, the thoracic or cervical spine becomes the site of the lesion. This is explained by the increased load in these areas. Regarding what exactly leads to the development of vertebrogenic myelopathy, a number of the most common factors are distinguished:

• intervertebral hernia;
• the condition of the spinal cord worsens with osteochondrosis;
• physical damage after blows, bruises, fractures;
• any displacement of the intervertebral discs, leading to pinching;
• ischemia of the vessels, provoked by their squeezing due to one of the points mentioned above.

Allocate acute and chronic forms of vertebrogenic myelopathy. In the first case, the disease develops rapidly due to severe injuries. In the second, we are talking about sluggish pathological processes that lead to the slow development of myelopathy.

spinal cord infarction

This type of disease is dangerous because an acute violation occurs in any part of the spinal cord. Therefore, it is almost impossible to predict the consequences. The cause of spinal cord infarction in most cases is a thrombus, pathology is more often observed in elderly people.
In this case, damage to the nerve fibers occurs, due to which you can lose sensitivity in certain parts of the body, in the limbs, often there is a loss of control over the muscles, and so on. In spinal cord infarction, myelopathy is accompanied by paraplegia, tetraplegia, or monoplegia.

Vascular

Vascular myelopathy is a pathological process that develops as a result of impaired blood circulation in the spinal cord. In most cases, we are talking about pathologies affecting the anterior and posterior spinal arteries.
Depending on the nature of circulatory disorders, two types of vascular myelopathy are distinguished:

1. Ischemic - due to partial obstruction of one or more vessels, which disrupts blood flow in a certain area of ​​the spinal cord. In most cases, the cause is the pathology of the spine, in which the vessels are clamped.
2. Hemorrhagic - a more severe form of the disease, in which there is a violation of the integrity of the vessel, accompanied by hemorrhage.

cervical

It is also often referred to as discogenic spondylogenic myelopathy. This type of pathological process is more often observed in older people due to age-related changes in bone and cartilage tissue.
Myelopathy of the cervical spine occurs when the mentioned area of ​​the spine is damaged. The main reason is the compression of the structures of the spinal cord due to the displacement of the vertebrae, the appearance of herniated discs, etc.
There is also a separate form of this type of pathology - cervical myelopathy, which is accompanied by more severe symptoms (a person may lose control of the upper limbs) and leads to disability.

Lumbar

The main difference from the previous type of disease is the place of localization. In addition, lumbar myelopathy is accompanied by completely different symptoms and complications.
In this case, the pathological process has the same causes, but the lesions concern the sensitivity of the lower extremities. In addition, dysfunction of the genitourinary system and rectum may appear.
A lesion in the region of the lumbar vertebrae threatens with loss of control over the lower extremities and paralysis.

Thoracic and thoracic

Myelopathy of the thoracic spine, as the name implies, is localized in the chest area. As for the thoracic type, we are talking about the lower part of the thoracic region. The development of the pathological process may be due to hernia, pinching or narrowing of the spinal canals.

degenerative

Degenerative myelopathy is directly related to circulatory disorders due to partial obstruction of the vessels responsible for blood circulation and feeding the spinal cord.
Among the factors contributing to the development of the described ischemia, which leads to circulatory disorders, there are mainly a deficiency of vitamins of groups E and B.
The symptoms in this case of the disease are extensive, people have disorders of motor functions, ranging from tremor of the limbs, and ending with a decrease in reflex abilities.

Compression and compression-ischemic myelopathy

These concepts unite a whole group of diseases that lead to the development of myelopathy in people of different ages.
Ischemic myelopathy is formed due to cervical spondylosis, as well as in pathologies accompanied by narrowing of the spinal canal or ischemia provoked by a neoplasm.
Compression myelopathy, as the name suggests, is caused by injuries to the spine that involve the spinal cord. These are severe injuries and fractures, disc protrusions. As well as compression, minor injuries are accompanied, in which the integrity of the blood vessels was violated.

Spondylogenic

Localization of the pathology falls on the cervical region. Myelopathy in this case is considered to be chronic. It develops due to the constant holding of the head by a person in a position that is incorrect from an anatomical point of view.
There is a syndrome of incorrect position of the head after injuries in the cervical spine, as well as in some neurological diseases.

Dyscirculatory myelopathy

Dyscirculatory myelopathy develops as a result of circulatory disorders in the cervical-brachial or anterior spinal arteries. In the first case, clinical signs are expressed in the dysfunction of the muscles of the upper extremities, while in the second case we are talking about a violation of the work of the nerve centers responsible for the sensitivity of the pelvic region. The severity of the clinical picture depends on the level of vascular damage.

Discogenic

Hernias occur between the vertebrae or their bone tissue grows. This compresses the vessels in the vertebral region and the spinal cord itself, which leads to the development of discogenic myelopathy.

Focal and secondary

When it comes to focal or secondary myelopathy, the cause is usually radiation exposure or ingestion of radioactive isotopes. This type of pathological process is characterized by special symptoms, in which the sensitivity of the skin of the hands and other parts of the body changes, the pathology is accompanied by skin rashes, ulcerations, destruction of bone tissues, etc.

Post-traumatic

The origin of this type of disease becomes clear from the name, we are talking about any injuries that affect the functions of the spinal cord. These can be blows, bruises, fractures, after which the victim is put on disability. Symptoms and consequences directly depend on the extent and level of spinal cord lesions.

Chronic

Chronic myelopathy develops for a long time, the symptoms are initially blurred, but as the pathological process progresses, it becomes more and more pronounced.
The reasons for the development of this type of pathology are extensive:

• multiple sclerosis;
• spondylosis;
• syphilis;
• infectious diseases and much more.

progressive

The cause of progressive myelopathy is a rare neurological disease in which an entire half of the spinal cord is affected - Charles Brown-Séquard syndrome.
The progression of this pathology leads to weakening or paralysis of the muscles of half of the body.

Symptoms

As you might guess from all that has been said earlier, myelopathy has a variety of symptoms, it all depends on the form and type of the pathological process. However, there are a number of common symptoms that are observed in patients in most cases:

• The first symptom is always pain in the neck or any other area, depending on the location.
• Also, the disease is often accompanied by an increase in body temperature up to 39 degrees of mercury.
• For most people, regardless of the cause, a symptom of myelopathy is a feeling of weakness in the whole body, a feeling of weakness, general malaise.
• Clinical signs are expressed in the form of dysfunction of individual parts of the body. For example, in cervical myelopathy, symptoms include muscle weakness and loss of upper limb control.
• Very often, with damage to the spinal cord, there are violations of the functions of the muscles of the back.

It is impossible to describe every symptom, there are too many of them. But remember, with the slightest muscle weakness, impaired coordination of movements, systematic numbness of the limbs, which are accompanied by general symptoms, you should consult a doctor.

Diagnosis of the disease

Diagnostic measures are needed to accurately establish the causes, determine the nature and type of the pathological process, confirm the diagnosis and prescribe treatment.
Diagnostics involves the following steps:

• blood tests, general, biochemical;
• puncture of the cerebrospinal fluid.

Depending on the indications and suspicions, additional examinations may be required.

Therapy

Treatment of myelopathy is carried out mainly conservatively, it involves long-term drug therapy. In cases where the disease progresses rapidly or there is a threat to human life, surgical intervention is required.
For a complete and effective treatment, it is important to seek help as early as possible. As for the methods of therapy, it involves the use of such groups of drugs:

• the fight against pain with the help of analgesics;
• reduction of edema through the use of diuretics;
• relief of muscle spasms is carried out with muscle relaxants and antispasmodics;
• if necessary, prescribe vasodilators, etc.

The specificity of treatment largely depends on the causes of the development of the disease, form, type and nature. That is why it is so important to consult a doctor and undergo a full diagnosis.