spinal cord compression
Introduction
Introduction to spinal cord compression Spinal cord compression is a common disorder in the nervous system. It is a group of intraspinal lesions with space-occupying features. There is obvious progressive clinical manifestation of spinal cord compression. As the etiology develops and expands, the spinal cord, spinal nerve roots, and their supply vessels are oppressed and become increasingly severe, causing spinal cord edema, degeneration, necrosis and other pathological changes that will eventually lead to the spinal cord. Loss of function, limb movement, reflex, sensation, sphincter function and skin dystrophy below the pressure plane, seriously affecting the patient's life and labor capacity. In general, if the disease is diagnosed and treated early, the prognosis is very good. Therefore, it is necessary to popularize and raise awareness and attention to spinal cord compression. basic knowledge The proportion of illness: 0.025% Susceptible people: no specific population Mode of infection: non-infectious Complications: urinary tract infections acne
Cause
Causes of spinal cord compression
(1) Causes of the disease
Tumor is the most common, accounting for more than 1/3 of the total number of spinal cord compression, vertebral body dislocation of spinal injury, dislocation and hematoma of the fracture, inflammatory and parasitic granuloma, abscess, disc herniation, spinal vascular malformation and some Congenital spinal lesions can cause spinal cord compression.
Tumor
(1) originated from the spinal cord tissue itself and its subsidiary structures: the majority, including tumors from the spinal nerve, spinal cord membrane, spinal cord glial cells, spinal cord blood vessels and fat connective tissue around the spinal cord, of which nearly half (about 47.13%) ) is a schwannomas, including a small number of neurofibromas, followed by meningioma, which is considered to be a malignant spinal glioma that accounts for only 10.87%. In addition, some congenital tumors, such as dermoid cysts, epithelium There are also cysts and teratomas, and the spinal epidural adipose tissue is abundant. Therefore, the occurrence of lipoma is not uncommon. The tumor can occur in any part of the spinal canal, but the nerve sheath is more common in the thoracic segment. Congenital tumors are more often than the lumbosacral region.
(2) malignant tumors originating from the spine and other organs: can also be invaded, transferred to the spinal canal and involve the spinal cord, in which malignant tumors of the lungs, breasts, kidneys, and gastrointestinal tract are common, and occasionally lymphoma, leukemia Those who invade the spinal cord and develop spinal cord compression symptoms.
2. Inflammation
Bacterial infections in other parts of the body can be disseminated by blood, direct spread of suppurative lesions adjacent to the spine, and direct implantation ("iatrogenic") can cause acute abscess or chronic true granuloma in the spinal canal. Compression of the spinal cord, more common in the epidural, subdural and intraspinal abscess is extremely rare, non-bacterial infective spinal arachnoiditis, as well as injury, bleeding, chemical such as intrathecal injection of drugs and some Arachnoiditis caused by unknown causes can cause spinal cord and inflammatory arachnoid adhesions, and even arachnoid cysts can compress the spinal cord. In addition, certain specific inflammations such as tuberculosis and parasitic granuloma can also cause spinal cord. oppression.
3. Damage
Spinal cord injury often occurs with spinal cord injury, and spinal injury can be caused by vertebral body, vertebral arch and lamina fracture, dislocation, facet joint interlacing, disc herniation, and intraspinal hematoma formation.
4. Spinal vascular malformation
Due to abnormalities in congenital embryo development, acquired diseases such as inflammation, injury, atherosclerosis, etc. can cause spinal vascular malformations. So far, there is no strong data to confirm that spinal cord vascular malformation causes spinal dysfunction, except for deformed blood vessels. The expansion and expansion have an oppressive effect, and due to short circuit of the artery, venous congestion leads to ischemic spinal cord injury.
5. Disc herniation
Also known as the nucleus pulposus, is also a common cause of spinal cord compression, often caused by excessive exertion or excessive stretching of the spine, excessive flexion, it is said that sneezing or forced coughing caused by disc herniation, this is rare, Disc herniation can also be caused by dehydration and aging of the nucleus pulposus itself. It can be seen in the lower neck of the neck without obvious damage factors. It can have more than one nucleus pulposus at the same time. The disease course is long and the symptoms progress slowly. This is a degenerative disease of the spine. portion.
6. Other
Some congenital spinal disorders, such as skull base depression, atlanto-occipital pillow, cervical fusion, spina bifida, spinal cord bulging, scoliosis and severe hypertrophic spinal osteoarthritis can cause spinal cord compression .
(two) pathogenesis
The spinal cord is deeply buried in the vertebral canal. The tissue structure and biological characteristics are similar to those of the brain tissue. The water content is rich, soft and fragile, incompressible, sensitive to blood oxygenation, etc. These characteristics are determined. The pathological changes and clinical features of the spinal cord on oppressive and ischemic damage. From the perspective of pathogenesis, different compression factors and their development speed determine the clinical manifestations.
Generally speaking, the influence of any kind of oppression on the spinal cord is always two-fold. One is mechanical compression and the other is blood supply disorder. The effect caused by mechanical factors is fast, symptoms appear almost immediately, and the damage is strong. After the pressure is relieved, The function recovery is slow, it usually takes several hours, and it can be gradually recovered after a few days. The various tissues of the spinal cord itself have different tolerance to stress. The tolerance of gray matter is generally larger than that of white matter, and the nerve fibers in the conduction beam are coarse. The tolerance to compression is worse than that of fine fibers, so it is easy to be damaged. The nerve fibers of the sense of touch and proprioception are thicker (diameter 12 to 15 m), and the nerve fibers of pain and temperature are finer (2 to 5 m in diameter). When both are under pressure, the former has symptoms earlier, but after the compression is relieved, the recovery is faster and more complete. Generally speaking, the longer the process from spinal cord compression to complete sexual dysfunction, the complete sexual dysfunction continues. The shorter the time, the faster the function recovery after the release of compression, the more complete, the effect of blood supply disorder is slow, the symptoms appear after blocking blood supply for 1 to 5 minutes, and the function recovery after recovery of blood supply is also fast, but if the blood supply is finished After blocking for more than 10 minutes, the spinal cord will produce severe ischemia, and the function is difficult to recover. In the early stage of spinal cord compression, the blood circulation disorder is reversible, but the degree of compression is increased and the time becomes too long, it becomes irreversible, and the blood supply in the distribution area after the arteries are compressed Insufficient, causing degeneration and softening of the spinal cord and congestion after venous compression, causing spinal cord edema, thereby aggravating spinal cord compression and damage. In tolerance to ischemia, white matter is more tolerant than gray matter, and fine fibers are stronger than crude fibers.
Clinical typing
Due to the different speed of development of pathogenic factors, spinal cord compression can be divided into acute, subacute and chronic types.
1. Acute compression is caused by multiple injuries (here, the formation of hematoma in the spinal canal or the compression of the spinal cord after injury), metastatic tumor, acute epidural abscess, intraspinal hemorrhage and other causes.
The volume of the space in a short period of time (1 to 3 days) exceeds the reserve space of the spinal cavity of the compression site, and the following pathological changes occur. Usually, venous return is blocked first, and the increase of venous pressure leads to excessive penetration of water. Extravascular, intercellular water increases, nerve cells in the compression area, glial cells and axons edema, increased spinal cord volume, exacerbated compression, further development of lesions lead to arterial blood supply disorders, cellular tissue hypoxia, metabolic disorders The accumulation of acidic products, increased cell membrane permeability, destruction of intracellular, extracellular potassium, sodium ion exchange, intracellular calcium overload, organelle dissolution and other biophysical changes, Fchlings and other multivariate regression analysis found spinal cord injury The degree and degree of ischemia are significantly associated with axonal conduction function after injury and will eventually lead to complete impairment of spinal cord function.
Under the microscope, the cell body and its axonal edema, intercellular fluid increase, cell and fibrosis, softening, breaking, dissolving liquefaction and necrosis, eventually forming fibrous connective tissue-like scar and arachnoid, dural adhesion, cerebrospinal fluid circulation blocked, The spinal cord below the compression plane is associated with loss of the central part, the cells gradually undergo atrophic changes, the nerve fibers are demyelinated, the spinal cord is reduced in size, and there is a different degree of adhesion to the arachnoid membrane.
The above pathological changes have reached the end, which is the pathological basis of spinal cord function loss. The degree of compression is different from the stage of oppression, and the changes are different. If the degree of compression is lighter or earlier, the cells only have edema and mild edema. At this time, if the pressure can be relieved, the damage is reversible. When the organelles have been dissolved and the cell body and the cell are disconnected, even if the compression factor is removed, the function is difficult to recover. Generally, the lesion is most severe in the central area under pressure.
2. Chronic compression This is a benign tumor in the spinal canal such as schwannomas, meningioma, lipoma, benign teratoma, cyst, etc., as well as spinal tuberculosis and certain congenital spinal deformities, due to the slow development of the lesion, the spinal cord is not Suddenly under pressure, while the lesion develops slowly, the spinal cord gradually acquires the ability to adapt and compensate for different degrees, or obtains sufficient blood supply due to the establishment of the collateral circulation, and can disappear from the adipose tissue in the spinal canal. Tube enlargement, lamina, pedicle and vertebral body thinning, bone erosion and other changes, so that the spinal cord compression is reduced.
The pathological changes of chronic compression are very different from those of acute compression. The cause of compression can exist for a considerable period of time. The spinal cord cavity is completely blocked, while the spinal cord can still have no obvious edema and swelling. On the contrary, the spinal cord becomes fine, and even the size is only Half of the original or smaller, the spinal cord is pushed to one side and bowed, and the compressed part presents a concave impression. The size of the spinal cord varies with the size of the lesion. The surface is slightly hyperemic, and there is arachnoid Different degrees of adhesion, nerve roots are pulled or oppressed, this is the pathological basis of root pain and segmental sensory or dyskinesia.
The above pathological changes determine the following clinical features of chronic spinal cord compression.
(1) Compensatory: The spinal cord compression process is slow and gradually acquires the ability to adapt and compensate. For a long period of time (months to more than 1 year), clinical symptoms may not occur, and the symptoms often appear as the compression increases. Orderly, extramedullary compression often first causes nerve root stimulation or damage symptoms, and may also cause corresponding damage symptoms due to compression of the immediately adjacent conduction beam, followed by a half-cut symptom of the spinal cord compression side, and finally lead to complete spinal cord function disorder. The whole process is often as long as 1 to 2 years. There are 2 cases of female schwannomas in the neurosurgery of Renji Hospital affiliated to Shanghai Second Medical University. The lesions are 4 years and 7 years respectively. The examination confirmed that the spinal canal is completely blocked. However, the patient can still handle housework and go up and down the stairs. The spinal cord that has been seen in the operation has been compressed to about 1/3 of the original size, which is enough to explain the tolerance and compensatory ability of the spinal cord to chronic compression.
(2) Volatility: The chronic spinal cord compression process is long, and the general trend of clinical symptoms is increasing. However, some cases may not be aggravated after a certain symptom or a group of symptoms appear, and may not be aggravated, or even There are relief or alleviation, heavy and light, light and complex, can be repeated, the fluctuation of this symptom, common in cystic changes of the tumor, vascular tumors and disc herniation, some patients with schwannomas also have fluctuations Sexual clinical manifestations, some are due to the relief of medication and physical therapy symptoms, the fluctuation of symptoms, if the curve shows that the peak is always higher than once, or accompanied by new symptoms or signs, the spinal cord will eventually appear Complete damage to function,
(3) Segmentality: The movement of the spinal cord and the sensory nerves have segmental features. The spinal cord is compressed in different segments, and there are movements in different parts, sensory and reflex disorders, and early root pain caused by extramedullary compression lesions. ", is the performance and characteristics of this segment device is stimulated.
(4) Multiple: tumor-induced spinal cord compression is more common in single-shot, but occasionally multiple tumors simultaneously or sequentially compress different planes of the spinal cord, such as multiple neurofibromatosis and metastatic tumors, in addition, arachnoid Cysts, inflammatory granuloma are also frequent.
3. Subacute compression is between the acute and chronic oppression, and will not be repeated.
Prevention
Spinal cord compression prevention
There are many determinants of the prognosis of spinal cord compression, such as the nature of the lesion, the possibility and extent of decompression, such as extramedullary epidural tumors are benign, the prognosis of surgical resection is good; the prognosis of intramedullary tumors is poor, usually the shorter the compression time, The smaller the spinal cord dysfunction, the more likely it is to recover. The acute spinal cord compression can not fully play the compensatory function, and the prognosis is poor. The treatment is mainly to prevent the compression of the spinal cord from various primary diseases, and advocate early surgery to relieve spinal cord compression; Neurotrophic metabolism drugs, such as B vitamins, vitamin E, citicoline, ATP, coenzyme A, and nerve growth factor, may partially improve the function of the spinal cord.
Complication
Complications of spinal cord compression Complications, urinary tract infection, acne
The longer the compression of spinal cord compression, the worse the prognosis after surgery; there is a urinary tract infection, and the prognosis of acne is poor.
Symptom
Symptoms of spinal cord compression Common symptoms Lower extremity muscles, cervical and cervical epilepsy, spinal cord compression, dyspnea, dry skin, spinal cord compression, urinary frequency, muscle atrophy, ascending skin, numbness, upper abdominal pain
The clinical manifestations vary with the nature of the lesion and the location of the lesion, the rate of development, and the extent of the spread. For example, spinal cord tumors usually progress gradually and gradually progress; spinal metastases and epidural abscess often cause acute compression symptoms; spinal cord compression symptoms caused by spinal tuberculosis can be relieved. In general, the development of its clinical symptoms is:
First, the symptoms of spinal nerve root compression:
Often due to compression of one or more posterior roots of the spinal nerves, burning pain, tearing pain or pain, and can be radiated to the corresponding skin segments, when the active spine, cough, sneezing can cause pain, the body position can be changed appropriately Relieved, this first symptom of root pain often has important diagnostic significance. Dural meningitis, extramedullary tumors, especially neurofibromatosis and various primary causes of spinal canal collapse, root pain is often prominent. Hypersensitivity or abnormal areas can often be found in the root pain area, and if the function is impaired, it can cause segmental sensation. If the lesion is located in the ventral aspect of the spinal cord, it can stimulate and damage the anterior root of the spinal nerve, causing segmental tendon and muscle atrophy.
Second, spinal cord compression symptoms
(1) Movement disorders. When the anterior horn of the spinal cord is compressed, there may be symptoms of segmental lower motor neuron spasm, which is manifested by atrophy of the limb or trunk muscle within the range of the damaged anterior horn, muscle weakness, and muscle fibrillation. When the cortical spinal cord is damaged, the limbs of the limbs below the pressure plane are increased, the muscle tension of the limbs is increased, the tendon reflex is hyperthyroidism, and the pathological reflex is positive. Chronic lesions start from one side and then to the other side; acute lesions often affect both sides, and there is a stage of spinal shock in the early stage (the limbs are flaccid paralysis below the lesion), and usually gradually transition to sputum after about 2 weeks. paralysis. If the lesion is in the lumbosacral segment, the symptoms of upper motor neuron damage will not appear.
(2) Feeling disorder. When the lesion damages the spinal thalamus bundle and the posterior bundle, it causes a bundled sensory disturbance that impairs the body below the plane. If the ascending sensory conduction beam path on one side is damaged first, it will appear as a deep sensory disturbance of the ipsilateral body below the plane and a shallow sensory disturbance on the contralateral side; when the lesion develops to the transverse damage of the spinal cord, the depth and depth of the lesion below the plane will be impaired. There are obstacles. Extramedullary compression lesions, pain and temperature disorders often start from the lower extremities, extending to the compression plane; intramedullary compression lesions, pain and temperature disturbances mostly extend from the plane. The plane of sensory disturbance often has a great reference value for the location of lesions.
(3) Abnormal reflection. If the reflex arc of the lesion is damaged, the normal physiological reflex in the segment is weakened or disappeared, which helps to locate the diagnosis. When one side of the pyramidal tract is damaged, the ipsilateral sacral reflex is below the lesion, the abdominal wall reflex and the cremaster reflex are slow or disappear, and the pathological sign is positive. When the bilateral cone is not affected by the wave, both sides of the lesion appear simultaneously. Abnormalities in reflection and pathology.
(4) Autonomic dysfunction: The skin below the lesion level is dry, sweat is less, the toe (finger) is rough, and the limb is edematous. Chronic compression lesions above the lumbosacral medulla, early urinary urgency is difficult to control; in the case of a sharply impaired shock period, automatic urination and defecation function loss, and later transition to incontinence. Lumbosacral pulp lesions are characterized by urine and stool retention. Intramedullary lesions have a bladder disorder earlier than extramedullary lesions. Lower cervical spinal cord lesions can produce Horner's sign.
During the chronic compression of the spinal cord, the development of spinal cord semi-transparent lesions to transverse lesions can be experienced. This phenomenon is easily seen with extramedullary tumors. Semi-transverse injury refers to deep sensory disturbances and pyramidal tract signs on the same side below the plane of damage and superficial sensory disturbances on the contralateral side (spiral hemisection syndrome); transverse damage refers to bilateral deep and shallow sensations, pyramidal tracts and Autonomic dysfunction.
Third, the symptoms of the spine:
The location of the lesion may have signs such as tenderness, cramps, deformity, and limited mobility.
Fourth, spinal canal obstruction:
Compressive myelopathy can cause incomplete or complete obstruction of the subarachnoid space of the spinal cord. It is manifested by a decrease in cerebrospinal fluid pressure during lumbar puncture, a lack of fluctuations in cerebrospinal fluid pressure with normal breathing and pulse, and a quinine test showing incomplete or complete obstruction. The appearance of cerebrospinal fluid may be yellowish or yellow, and the amount of protein is increased. After the lumbar puncture, the neurological symptoms may be aggravated. When the lumbar puncture is suspected, the patients with high cervical medullary lesions should be extra careful to avoid the symptoms from aggravating and causing respiratory muscle paralysis.
Examine
Examination of spinal cord compression
Laboratory inspection
Cerebrospinal fluid examination: lumbar puncture measures cerebrospinal fluid dynamic changes and routine, biochemical examination is an important method for the diagnosis of spinal cord compression.
Cerebrospinal fluid dynamics change
When the oppressive lesions cause the subarachnoid space of the spinal cord to block, the intracranial pressure can not be transmitted to the subarachnoid space of the spinal cord below the obstruction level. Therefore, the spinal subarachnoid space below the obstruction level is low, sometimes not even measured. See normal or even elevated pressure, which is mostly partial or non-obstructed cases, the pressure of complete obstruction is generally low, and there is no fluctuation of cerebrospinal fluid level, pathological changes of cerebrospinal fluid pressure for diagnosis of spinal cord compression and subarachnoid obstruction Great meaning.
There are roughly three results for cerebrospinal fluid dynamic tests:
1 spinal arachnoid space without obstruction;
2 partial blockage;
3 completely blocked, the horsetail lesion (tumor) for lumbar puncture when the needle has the possibility of piercing the tumor, then the cerebrospinal fluid is not available, if the liquid may be the tumor cyst fluid, the color is generally yellow, thicker, the pressure is not The impact of the dynamic test, do not mistakenly believe that the subarachnoid space is completely blocked. At this time, the first or two intervertebral spaces should be selected to re-puncture. If the cerebrospinal fluid is obtained, the lesion can be judged. The size of the tumor is caused by the cobweb. The main factors of obstruction of the subvalvular space, but the adhesion of the arachnoid surrounding the tumor also has an important effect. In addition, the lumen of the thoracic vertebra is narrower than the lumbar segment and the lower neck. The same size of the tumor is in the thoracic segment than the lumbar segment, the neck segment Causes complete obstruction earlier.
2. Cerebrospinal fluid cell count
Generally in the normal range, inflammatory lesions have more white blood cells; tumors with hemorrhagic necrosis may increase red blood cells and white blood cells.
3. Cerebrospinal fluid color and protein content
Those with low protein content are colorless and transparent, and those with high protein content are light yellow to orange. The amount of protein is from hundreds of milligrams to more than 1g per 100 milliliters. It can be self-coagulated by aside, called self-coagulation, and the protein content of cerebrospinal fluid in spinal cord compression. How much is related to the degree of spinal subarachnoid obstruction, the time of obstruction and the level of obstruction. The more complete the obstruction, the longer the obstruction time, the lower the obstruction level, the higher the protein content, and the tumor compression than the non-neoplastic compression. High protein content, especially schwannomas, mostly in the subarachnoid space, the protein content of cerebrospinal fluid is higher than other types of tumors, spinal cord compression caused by increased protein content of cerebrospinal fluid, but also because the spinal cord supply blood vessels are oppressed The lack of oxygen in the blood, the permeability of the blood vessel wall is increased, the protein exudation is increased; and the subarachnoid space is blocked, so that the distal cerebrospinal fluid cannot participate in the normal circulation, and a small amount is absorbed and concentrated.
It should be pointed out that when the lumbar puncture is used for cerebrospinal fluid dynamics examination, the movement of the tumor may be aggravated or the pain is aggravated due to the possibility of causing the movement of the tumor position (such as a schwannoma), which must be estimated beforehand.
According to medical history and physical examination, it is not difficult to judge spinal cord lesions, but it is not easy to accurately determine the extent, nature and nature of the lesion. Although some valuable clinical signs are available for localization diagnosis, the error is often The difference between the judgment of the degree and nature of the lesion and the actual situation is even greater. Therefore, further examination is generally required, especially when considering the operation or radiotherapy, it is indispensable to select a suitable auxiliary examination.
Film degree exam
1. Spinal X-ray film
Orthotopic position, lateral position, if necessary, plus oblique position, spinal injury focused on the presence or absence of fractures, dislocations, dislocations and intervertebral space stenosis, etc., about 50% of benign tumors may have positive appearance, such as pedicle spacing widened, vertebrae Deformation or blurring of the arch, enlargement of the intervertebral foramen, depression of the posterior margin of the vertebral body or osteoporosis and destruction, common bone destruction of metastatic tumors, no change in the early stage of the disease, the longer the course of the disease, the higher the incidence of bone changes, the degree Also heavy.
2. Magnetic resonance imaging (MRI)
It can clearly display the tomographic images of different axes, provide a clearer anatomical structure, provide the most valuable information on the location of the spinal cord lesions, upper and lower borders, location and properties, and is the most valuable for diagnosing spinal cord lesions. tool.
3.CT
The tumor with higher resolution can be detected less than 5mm, and the image is clearer, which can clearly show the relationship between tumor location and tumor and spinal cord.
4. Myelography
A medical unit without MRI, CT equipment, can help diagnose.
5. Radionuclide scanning
Apply 99mTc, or 131I (sodium iodide) 10mCi, through the lumbar puncture injection, half-hour after the full-length scan of the spinal cord, can accurately determine the obstruction site, the patient has less pain and less reaction.
Diagnosis
Diagnosis and diagnosis of spinal cord compression
Diagnosis can be based on medical history, clinical symptoms, and laboratory findings.
Differential diagnosis
1. The difference between spinal cord compression and non-oppression
Early spinal cord compression often has symptoms of root pain. Therefore, it needs to be differentiated from certain visceral diseases that can cause pain symptoms, such as angina pectoris, pleurisy, cholecystitis, stomach or duodenal ulcer, and kidney stones. Sexual confusion, generally found through symptomatic drug treatment and neurological examination, signs of spinal cord injury can be identified, and when spinal cord compression signs appear, it needs to be further differentiated from non-compressive spinal cord lesions.
(1) spinal arachnoiditis: the disease is slow onset, the course of disease is long, the symptoms are up and down, and there may be root pain, but the range is often wider. During the remission period, the symptoms can be obviously alleviated or even disappeared. The spine X-ray film More normal, cerebrospinal fluid dynamic test mostly showed partial obstruction, accompanied by cyst formation, can be completely blocked, cerebrospinal fluid leukocytosis, protein can be significantly increased, myelography can be seen in the subarachnoid space scattered into irregular droplets, beaded, Or split into a number of tracks and not related to each other, the shape is special, easy to identify.
(2) acute myelitis: the onset is more urgent, often have systemic discomfort, fever, muscle soreness and other prodromal symptoms, spinal cord damage symptoms often appear suddenly, develop to a peak within a few hours to several days, the affected plane is clear and easy to detect, The limbs are mostly loose sputum, combined with sensory and sphincter dysfunction, should be carefully identified with acute disc herniation without obvious trauma. The spinal cord subarachnoid space is not obstructed, and the number of white blood cells in the cerebrospinal fluid is increased to mononuclear and lymphocytes. Mainly, the protein content is also slightly increased. If the bacteria are caused by neutrophils, the protein content is also significantly increased.
(3) syringomyelia: insidious onset, long course of disease, early symptoms are often atrophy and weakness of small muscles in the hand, lesions are more common in the lower neck and upper thoracic segment, also extended to the medulla oblongata, most cases are spinal cord The embryonic development is abnormal. The lesion is characterized by a long cavity near the central canal of the spinal cord, and there is glial hyperplasia around it. Therefore, the main features of clinical manifestation are sensory separation below the lesion level, ie pain, temperature loss, touch and position, vibration. Shear preservation, lower limbs have signs of pyramidal damage, root pain is rare, skin nutrition changes are often significant, may have a family history, waist wear without obstruction, cerebrospinal fluid examination is generally normal.
(4) Hypertrophic changes of the spine and bone joints: more common in middle-aged patients, lesions are most common in the lower neck and lumbar segments. The neck segment has initial numbness or shoulder pain, heavy feelings, and other symptoms, spinous processes or spines. There is tenderness next to the sudden, the symptoms are often aggravated by the improper position of the neck. In severe cases, the palm muscle group shrinks, the Hoffmann test is positive, and the vertebral artery ischemic symptoms such as dizziness or dizziness can occur when turning the head position. X-ray The film showed obvious hypertrophy of the bones and joints, the physiological curvature of the spine disappeared, and it was strong and straight. The common lumbar vertebrae were found. The examination of cerebrospinal fluid was normal. Some cases may be accompanied by intervertebral disc herniation. The subarachnoid space was incompletely obstructed. The protein content of cerebrospinal fluid was also Increase accordingly.
(5) Amyotrophic lateral sclerosis: a degenerative disease, the lesion mainly involves the anterior horn cells of the spinal cord, the medullary motor nucleus and the pyramidal tract, so it is mainly dyskinesia, generally no sensory disturbance, and may have roots in the early stage. Pain, its characteristic manifestations are upper limb hand muscle atrophy and tongue muscle atrophy. In severe cases, it has difficulty in constructing sound. When the motor neurons above the lesion are dominant, the tendon reflex is hyperthyroidism, the spinal cord cavity is not obstructed, the cerebrospinal fluid is normal, and the biochemical examination is normal.
(6) Spinal cord compression combined with several rare clinical symptoms:
1 compression lesions in the high neck segment, often accompanied by cranial nerve palsy, especially in the large hole area of the cerebral cranial tumor, such as hoarseness, difficulty swallowing, shrugging weakness, when the trigeminal spinal cord is compressed, there is head and head pain Decreased, corneal reflex is weakened, occasionally seen in multiple neurofibromatosis, and spinal cord tumor is accompanied by an acoustic neuroma.
2 horizontal nystagmus is also more common in sinusoidal tumors, due to compression of the medial longitudinal bundle (this bundle mainly coordinates eye movements, can reach T1 level from the midbrain), or affects the cerebellum due to lesions, or edema caused by blood circulation disorders, etc.
3 spinal cord tumor with optic disc edema, lumbosacral tumor is more common, but the overall incidence is not high, in addition to the discovery of cerebrospinal fluid protein in the clinical examination, there is no abnormality in the skull, the optic disc edema disappears after tumor resection, the possible cause is tumor It affects the absorption of cerebrospinal fluid or accompanied by the increased pathological secretion of cerebrospinal fluid.
The above rare cases should be noted in the differential diagnosis.
2. Spinal compression plane positioning
Early segmental symptoms, such as root pain, hypersensitivity areas, muscle atrophy, and decreased or absent tendon reflexes, contribute to the positioning of the compression plane, so it is necessary to be familiar with the relationship between the spinal cord segment and the spine, the spinal cord segment and the dominant muscle. The position of each shallow reflex and tendon reflex center, in addition to the sensory plane, is also important for positioning. Generally speaking, the boundary between the lighter zone and the hyperesthetic zone is the upper edge of the compressed segment. The upper boundary causing the defensive reflex zone can often represent the lower edge of the spinal cord compression. Myelography or CT, MRI can accurately make a localization diagnosis.
3. Identification of intramedullary compression and extramedullary compression
The order of clinical symptoms can be used as a reference for identification, such as root pain, exercise, centripetal and centrifugal development of sensory disturbances, sphincter dysfunction, etc., but only by clinical identification, sometimes large errors are inevitable, so before surgery It must also be determined by myelography, CT or MRI (Table 1).
4. Determine the nature of the cause of oppression
The analysis of the nature of the lesion is helpful for preoperative preparation and prognosis estimation. Generally, intramedullary or extramedullary subdural compression is the most common tumor, and extramedullary epidural compression is more common in intervertebral disc herniation, lumbar region. More common in the lower neck, often history of trauma, inflammatory compression, such as hard spinal abscess, rapid onset, accompanied by fever and other inflammatory features, hematoma compression, often history of trauma, symptoms, rapid progression of signs, metastatic tumors, such as Sarcoma, lymphosarcoma, etc., onset faster, root pain is obvious, spine bone often has obvious damage, comprehensive medical history, clinical examination and auxiliary examination data, careful analysis, most cases can be correctly diagnosed before surgery.
