cervical spondylosis
Introduction
Introduction to cervical spondylotic myelopathy Although this type of cervical spondylosis is more rare than the former two types, but the symptoms are serious, and most of them develop in the form of recessive invasion, which is easily misdiagnosed as other diseases and delays the timing of treatment. Therefore, it is in an important position in various types due to its main oppression. Or stimulating the spinal cord and accompanying blood vessels and the sensation, movement, reflex and defecation dysfunction of the spinal nerve, so it is called cervical spondylotic myelopathy. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications:
Cause
Causes of cervical spondylotic myelopathy
Causes
Due to congenital, dynamic, mechanical and other factors, the spinal cord and accompanying blood vessels are stimulated by the stimulation of the disease.
Congenital factors (15%):
Congenital factors mainly refer to cervical vertebral canal developmental stenosis. From the etiology point of view, it is the pathological anatomical basis of the following three, unless the space of the space-occupying lesion is too large (such as osteophytes, tumors and broken bone fragments, etc.) The incidence of cervical spondylotic myelopathy in patients with large spinal canal is significantly lower than that of cervical spinal canal stenosis. Even if symptoms appear, it is more mild and easy to cure.
Dynamic factor (20%):
The dynamic factors mainly refer to the instability and loosening of the vertebral ganglia, the bulging and invagination of the posterior longitudinal ligament, the posterior process of the nucleus pulposus, the lordosis of the ligamentum flavum, and other possible protrusions to the spinal canal, which induce pressure on the spinal cord. It can also disappear or reduce due to changes in body position.
Mechanical factors (25%):
Mechanical factors refer to bone hyperplasia, spur formation and nucleus pulposus detachment, including local or subarachnoid gap formation of adhesions can not be repaid, most of these factors are based on congenital and dynamic factors and the formation of continuous compression of the spinal cord.
Vascular factors (25%):
Spinal cord blood vessels and their blood supply, like the blood vessels of the brain, have a very amazing ability to regulate the blood supply of the spinal cord in various complex activities; the blood supply in normal and abnormal state can be about 20 times different, if When the blood vessels of the group are stressed or stimulated, sputum, stenosis and even thrombosis may occur, so that the blood supply to the spinal cord is reduced or interrupted, and the parts of the ischemic are different, and various spinal ischemic symptoms are exhibited in the corresponding dominant areas. In severe cases, there may be irreversible consequences. The representative clinical manifestations of spinal cord ischemia include: quadriplegia caused by compression of the anterior central artery (the lower limbs are heavy), and the central artery of the spinal cord is compressed by the sulcus. Anterior ischemic, upper extremity spasm (also can affect the lower extremities); pia mater ischemia, causing spinal cord irritation; and spinal cord degeneration caused by obstruction of the large root artery, etc., which is clinically difficult to detect, actually It plays an important role in the pathophysiological changes of the spinal cord. For example, during surgery, only the nucleus pulposus is removed, and the symptoms of quadriplegia can be quickly alleviated or even disappeared. An alarming rate can only be explained by vascular factors, therefore, the important role of vascular factors in the clinic should be fully estimate, this choice of timing of surgery and determination also of great significance.
The above four factors are easy to cause the spinal cord tissue in the bone fiber pipeline to be stimulated and oppressed. In the early stage, on the basis of the spinal stenosis, the spinal cord itself or the anterior spinal artery and the sulcus artery are stimulated by the dynamic factors. Symptoms such as increased tension, hyperreflexia and hypersensitivity, and greater volatility, while in the later stage, due to mechanical factors (osteogenesis, etc.), the pressure on the spinal cord continues to persist, not only the symptoms and signs are gradually increasing. It is aggravated and can form a consequence that is difficult to reverse.
Prevention
Spinal cervical spondylosis prevention
First, pay attention to proper rest and avoid lack of sleep. Insufficient sleep, overworked tension, and constant maintenance of a fixed posture for a long time will lead to excessive nervousness of the nerves and strengthen the symptoms of cervical spondylosis.
Second, changing the habit of using the pillow, the physiological curvature of the vertebra (referred to as the neck curvature) is not static. With the increase of age, the cervical vertebrae will have degenerative changes, cervical vertebrae hyperplasia, and thus the neck curvature will change, and even the neck curvature will be straight or reversed.
Third, active exercise, especially the exercise of neck and back muscles, correct exercise can strengthen muscle strength, strengthen normal cervical curvature, increase the stability of cervical biomechanical structure, and promote blood lymphatic circulation, favorable for cervical spondylosis Recovery.
Fourth, hot compresses can be used to relieve local neuromuscular tension.
Complication
Cervical spondylotic complication Complications
Can be complicated by spasm and urination, defecation dysfunction.
Symptom
Symptoms of cervical spondylotic myelopathy Common symptoms Constipation, head, neck, shoulder... Urinary frequency urinary spurs form soft legs, spinal cord compression, muscle atrophy, sensory disturbances
Cone beam sign
It is the main feature of cervical spondylotic myelopathy. The mechanism of its production is caused by the direct compression of the cone-shaped bundle (corticospinal tract) or the reduction of local blood supply. It is clinically weak from the lower limbs and the legs are tight ( Such as the binding leggings) and the heavy feeling of lifting, etc., gradually appear foot cotton, stepping and drifting, limping, easy to fall (or fall), the toes can not leave the ground, gait stupid and chest feeling and other symptoms, Typical pyramidal tract symptoms such as hyperreflexia, convulsions, hernias and muscle atrophy can be found during examination. Abdominal wall reflexes and cremaster reflexes mostly decrease or disappear, and hand holdings are easy to fall (indicating that the deep part of the pyramidal beam has been affected) Finally, it is presented as a defamatory ambiguity.
The order of the pyramidal bundles in the marrow, from the inside and outside of the neck, upper limbs, chest, waist, lower limbs and ankle nerve fibers, depending on the location of the affected can be divided into the following three types:
(1) Central type (upper limb type): It is the first part of the pyramidal beam that is involved. Because the nerve fiber bundle is close to the central tube, it is also called the central type. The symptoms start from the upper limb, then the square wave and the lower limb, and its pathological changes. Mainly due to compression or stimulation of the sulcus artery, such as one side of the pressure, showing one side of the symptoms; bilateral compression, there are bilateral symptoms.
(2) Peripheral type (lower limb type): refers to the pressure acting on the surface of the pyramidal beam first, so that the lower limbs first appear symptoms. When the pressure continues to increase and spread to the deep fibers, the symptoms extend to the upper limbs, but the extent is still lower than the lower limbs. The mechanism of the occurrence is mainly the direct compression of the anterior wall of the dural sac by the epiphysis of the anterior or posterior nucleus of the spinal canal.
(3) anterior central vascular type (four-limb type): that is, the upper and lower limbs are simultaneously affected, mainly due to the involvement of the anterior central artery of the spinal cord, causing symptoms of anterior spinal cord ischemia by affecting the dominating area of the blood vessel. It is characterized by rapid illness and healing through treatment; non-surgical therapy is effective.
The above three types can be divided into light, medium and heavy according to the severity of the symptoms. Mild refers to the early symptoms. Although there are symptoms, they can still work. The medium refers to the loss of working ability, but personal life. If you have been in bed, you can't go to the ground, and you can lose your ability to take care of yourself. It is severe. If you are severely removed, you can still recover the pressure. If you continue to develop, the spinal cord may become degeneration or even cavity formation. , the spinal cord function is difficult to obtain a reversal.
2. Limb numbness
Mainly due to the simultaneous involvement of the spinal thalamus bundle, the order of the bundle fibers is similar to that of the former. The nerve fibers of the neck, upper limbs, chest, waist, lower limbs and ankle are from the inside to the outside. Therefore, the location and classification of the symptoms appear. Consistent with the former.
In the spinal thalamic tract, the distribution of the temperature-sensing fiber and the tactile fiber is different, and thus the degree of compression is also different, that is, the pain, the temperature-sensing disorder is obvious, and the touch may be completely normal, and the separation-like sensory disorder is easy to The syringomyelia is confused and should be identified clinically.
3. Reflection disorder
(1) Abnormal physiological reflex: Depending on the lesion and the segment of the spinal cord, the physiological reflexes are correspondingly changed, including the biceps reflex of the upper limb, the triceps reflex and the periosteal reflex of the tibia, and the knee reflex of the lower limb and Achilles tendon reflexes, mostly hyperactive or active, in addition, abdominal wall reflex, cremaster reflex and anal reflex can be weakened or disappeared.
(2) Pathological reflex: The highest positive rate was observed by Hoffmann's sign (Fig. 1) and palmar reflex; in the later stage of the disease, sputum, sputum and Babinski signs may appear.
4. Autonomic symptoms
Clinically, it is not uncommon, and it can involve various systems of the whole body. Among them, the gastrointestinal tract, cardiovascular and urinary system are more common, and many patients are reminiscent of cervical spondylosis after the symptoms are improved after decompression. If you do not ask in detail before surgery, it is often difficult to find out.
5. Defecation, urinary dysfunction
Most appeared in the later stage, initially with urgency, poor bladder emptying, frequent urination and constipation, gradually causing urinary retention or incontinence.
6. Flexion test
This type is most afraid of flexing the neck, such as sudden head and neck flexion, due to the sudden reduction of the effective gap in the spinal canal, causing the spinal cord to be sensitive to irritability, in patients with cervical spondylosis, the lower limbs or The limbs may have an electric shock-like sensation (Fig. 2). This is mainly because, in the case of flexion, not only the volume of the spinal canal is reduced, but also the osseous or cartilage-induced compressors in front of the spinal can directly hit the spinal cord and its blood vessels. At the same time, the tensile pressure formed by the posterior wall of the dural sac increases the compressive stress on the spinal cord.
Examine
Examination of cervical spondylotic myelopathy
1. X-ray film and dynamic lateral film
The main performance is:
(1) The sagittal diameter of the spinal canal is mostly smaller than normal: according to the ratio, the ratio of the sagittal diameter of the vertebral body to the spinal canal is mostly below 1:0.75; the absolute value is also less than 14mm, and about half of the cases are below 12mm.
(2) Trapezoidal changes: Most cases with short course of disease are mostly caused by prominent or prolapsed nucleus pulposus and unstable vertebral segments. Therefore, the intervertebral body joints on the dynamic lateral radiographs can show obvious trapezoidal changes. The time of appearance is earlier than that seen by the MRI technique. Similarly, in cases where bone spurs have formed, the adjacent nodes begin to change from trapezoidal (spine instability) before the spurs appear.
(3) Bone spur formation: About 80% of the cases have obvious spur formation at the posterior edge of the affected vertebral body, and the sagittal diameter can be 1 to 6 mm or longer, and is generally 3 to 5 mm.
(4) Other changes: Some cases may be associated with calcification of the posterior longitudinal ligament, congenital vertebral fusion (more than 3 to 4 of the neck) and anterior longitudinal ligament calcification, such abnormalities and the occurrence of this type of symptoms It is also closely related to development.
2. MRI technology MRI image
For example, a longitudinal section anatomical view of the spinal cord and surrounding tissues can make the local lesions clear at a glance, so each case should be selected for use, which is not only critical for the diagnosis and classification of cervical spondylosis, but also for the decision of surgery. The determination of the part and the choice of the procedure are of great significance.
3. Other
Including CT examination, myelography and other effects on the diagnosis of this type, may be selected as appropriate.
Diagnosis
Diagnosis and diagnosis of cervical spondylotic myelopathy
Diagnose based on
1. Clinically, the spinal cord compression performance is divided into central type, peripheral type and central vascular type, and the three can be divided into heavy, medium and light.
2. Imaging examination can show the sagittal stenosis of the spinal canal, vertebral instability (trapezoidal change), bone hyperplasia (bone formation), dural sac compression and spinal cord signal abnormalities and other imaging findings.
3. Except for other diseases including amyotrophic lateral sclerosis, syringomyelia, spinal cord hernia (late syphilis), skull base depression, polyneuritis, spinal cord tumor, secondary adhesion vertebral arachnoiditis Disorders and multiple sclerosis, etc., note that cases where two or more diseases coexist can be found clinically.
4. Other lumbar puncture, EMG and evoked potentials may be selected as appropriate to assist in diagnosis and differential diagnosis.
Differential diagnosis
Cervical spondylotic myelopathy is a disorder mainly caused by movement disorders. It is easy to be confused with various diseases of neurology, especially the violation of motor neurons. It should be carefully identified. The two methods are not only different in treatment, but also have a poor prognosis. Large, clinically encountered are mainly the following various diseases.
1. Amyotrophic lateral sclerosis
(1) Overview: This disease belongs to a type of motor neuron disease, and its etiology is still unclear. It mainly causes the upper extremity symptoms to be more severe than the lower limbs of the extremities, so it is easy to be confused with cervical spondylotic myelopathy. There is currently no effective (even in the surgery) therapy, the prognosis is poor, surgery can aggravate the condition or cause death; while patients with cervical spondylotic myelopathy need early surgery, so the two must be identified, Clear diagnosis and selection of appropriate treatments.
(2) Identification points:
1 age characteristics: patients with cervical spondylotic myelopathy are more than 45 to 50 years old, and the age of onset of this disease is earlier, often starting around 40 years old, young people are even around 30 years old.
2 sensory disorder: the disease generally has no sensory disturbance, only some cases may have a paresthesia complaint; and in patients with cervical spondylosis, when the spinal cord compression causes dyskinesia, they are accompanied by symptoms and signs of sensory disturbance.
3 speed of onset: cervical spondylosis is slower, and more associated with certain incentives; and this disease is more than any cause of sudden onset, often starting from muscle weakness, and the disease develops rapidly.
4 muscle atrophy: Although the disease can occur in any part of the body, but the upper limbs are more pre-existing, especially the small muscles of the hand are obvious, large, small fish muscles and sacral muscles are atrophy, the metacarpal space is concave, hands can be It is eagle-claw-like and rapidly develops to the forearm, elbows and shoulders, and even causes neck muscle weakness and atrophy. Therefore, the sternocleidomastoid muscle, scapula levator muscle and neck muscle group should be routinely examined in such cases. There is no sign of atrophy, and cervical spondylosis is more common in the neck than 5-6, neck 6-7 and neck 4-5, so the level of muscle involvement rarely exceeds the shoulder.
5 autonomic symptoms: this disease is rare in patients with this symptom, but often encountered in patients with cervical spondylotic myelopathy.
6 dysphonia: when lateral sclerosis and medulla oblongata (can occur at the onset, but more common in the later stages of the disease), can appear ambiguous, gradually affecting masticatory muscles and swallowing movement, while patients with cervical spondylotic myelopathy This symptom only has mild dysphonia when the lesion affects the vertebral artery.
7 sagittal diameter of the spinal canal: most of the disease is normal, and patients with cervical spondylotic myelopathy show more obvious signs of stenosis.
8 cerebrospinal fluid examination: patients with cervical spondylosis often have incomplete obstruction and abnormal biochemical examination of cerebrospinal fluid, and this disease is mostly normal.
9 myelography: the disease is negative, and patients with cervical spondylosis have positive findings.
10 Others: including the EMG signs, muscle biopsy and CT and MRI examinations in each stage of the disease, are helpful for the differential diagnosis of this disease and cervical spondylotic myelopathy, see Table 1.
The prognosis of this disease is poor. At present, there is no effective measures to prevent the progress of the disease, and many deaths or respiratory disorders often occur several years to more than ten years after onset.
2. Primary lateral sclerosis: The disease is similar to the former, except that the motor neuron degeneration is limited to the upper motor neurons and does not affect the lower motor neurons, which is less common than the former, mainly characterized by progressive, tonic paraplegia or Quadriplegia, no sensory and bladder symptoms, such as lesions and cortical medullary bundles can appear false bulbar palsy (pseudobulbar paralysis) signs, the identification method is consistent with the former.
3. Progressive spinal muscular atrophy: progressive spinal muscular atrophy refers to neuronal degeneration limited to the anterior horn cells of the spinal cord and does not affect the upper motor neurons. Muscular atrophy is first confined to a part of the muscles, and gradually affects the whole body. Myasthenia gravis, muscle atrophy and fasciculation, the strong and straight signs are not obvious, and the differential diagnosis method is similar to amyotrophic lateral sclerosis.
4. Syringomyelia
(1) Overview: This disease and medullary cavity disease are chronic degenerative diseases characterized by intramedullary cavity formation and gliosis. The disease progresses slowly, and the upper limbs are affected early, showing a segmental distribution. When the cavity is gradually enlarged Because of the pressure or gliosis, the long-conducting bundle in the white matter of the spinal cord is also involved, and the disease is clinically confused with cervical spondylotic myelopathy.
(2) Identification points:
1 Sensory disorder: The early stage of the disease is a side pain and temperature sensory disorder. When the lesion spreads to the anterior commissure, there may be bilateral hands, forearm ulnar side and part of the neck, chest pain, temperature loss, and touch. The deep feeling is basically normal. This phenomenon is called sensory separation disorder, and this phenomenon is not seen in patients with cervical spondylosis.
2 nutritional disorders: due to pain disorders, not only local ulcers, burns, subcutaneous tissue thickening and perspiration dysfunction and other diseases, and can cause excessive proliferation and wear changes in the joints, and even over-limit activities No pain, this is called the Xia Ke joint, should be noted and identified due to spinal cord spasm (mainly according to the history of smelting, history and serum syphilis response, etc.).
3 other: can also refer to other signs, age, cervical X-ray film, cervical spinal canal diameter measurement and lumbar puncture, etc., summed up the above content, list 2, for reference, MRI, CT or myelography, etc. Help to confirm the diagnosis of this disease.
In the past, surgery was not recommended for this disease, but in recent years, the authors have found that the use of spinal median incision decompression and silicone tube drainage can reduce intramedullary pressure. The long-term efficacy of about half of the cases can be maintained for many years. In cases with more than 10 years of efficacy, the disease develops slowly and the prognosis is better than the former.
5. Ataxia: This disease has obvious hereditary characteristics, and it is divided into juvenile spinal cord ataxia (also known as Friedreich ataxia), vertebral cerebellar ataxia, and cerebellar type. There are several types of ataxia and peripheral ataxia, and there are many subtypes.
The disease is not difficult to distinguish from cervical spondylotic myelopathy. The key is to have a clear understanding of the disease. When examining the patient, attention should be paid to the presence of limb ataxia, nystagmus and low muscle tone. Positive results are Help with the judgment of this disease.
6. Skull base depression
(1) Overview: In recent years, it has been found that this disease is not uncommon. Because there is no specific treatment, the patients often seek treatment between the outpatient clinics of various hospitals. Because they can cause spinal cord compression symptoms, they should be differentiated from cervical spondylotic myelopathy.
(2) Identification points: Main basis: The disease is a congenital malformation with its inherent clinical features:
1 short neck appearance: mainly due to the concave of the upper cervical vertebrae into the skull.
2 marker measurement abnormalities: the following two are commonly used in clinical practice:
A. Skull base angle: refers to the angle formed by the saddle and the slope. It is measured by the lateral slice of the skull and is normally 132°. If it exceeds 145°, it is a flat skull base.
B. Hard -pillow large hole line: also known as Chamberlain line, that is, the line connecting the trailing edge of the hard palate to the upper edge of the occipital foramen. Under normal circumstances, the tip of the odontoid of the vertebral column is lower than this line, such as higher than this line. It is a flat skull base.
3 Others: The age of onset of this disease is earlier, and it can start from 20 to 30 years old. The clinical manifestations are quadriplegic spasm, and its location is higher than that of patients with cervical spondylotic myelopathy. Painful torticollis deformity and other deformities of the cervical spine bone; intracranial symptoms may occur if the intracranial pressure is increased in the later stage of the disease.
7. Multiple sclerosis
(1) Overview: This disease is a central nervous system demyelinating disease whose cause is not well understood. It is easy to be confused with cervical spondylotic myelopathy because of pyramidal tract symptoms and sensory disturbances.
Although this disease is rare in China, it is not uncommon. It can cause sensory disturbances and limb spasm of the cervical spondylotic myelopathy. Therefore, the disease should be considered in the diagnosis. There is no specific treatment for this disease. Can aggravate the condition and even cause an accident, so avoid misdiagnosis.
(2) Identification points: mainly based on the following five points for identification:
1 good age: more than 20 to 40 years old, more women than men.
2 psychiatric symptoms: more than a different degree of mental symptoms, often euphoria, emotional impulses.
3 dysphonia: lesions and cerebellum can appear unclear, and even vocal cords.
4 cranial nerve symptoms: the optic nerve is involved, other brain nerves can also spread.
5 ataxia symptoms: can appear when the lesion spreads to the cerebellum.
8. Spinal cord fistula
(1) Overview: Spinal cord sputum is a late stage of syphilis, and its pathological changes are mainly located in the posterior root and posterior bundle of the spinal cord, especially in the lumbosacral region, more than 10 to 30 years after the initial infection, which is less common, but some These areas are still available.
(2) Identification points:
1 There is a history of smelting tour: it should be repeated in detail.
2 Lightning-like pain: The lower extremities are more common, causing burning or tearing pain. After the pain disappears, there is hypersensitivity at this place, which is caused by stimulation of the posterior root somatic nerve.
3 Ataxia: Due to deep sensory disturbance, the main manifestation is gait sputum, and it is spanning; patients often complain that there is a cotton-like feeling when walking.
4 visual impairment: due to optic atrophy, early vision loss, visual field is concentric, and finally blind.
5 Argyll-Robertson pupil: that is, the adjustment of the pupil is normal, and the reflection of light disappears or is delayed.
6 low muscle strength: especially the lower limbs are obvious, knee reflex can even disappear.
7 Kanghua reaction: The positive rate of serum Kanghua reaction is about 70%; the positive rate of Fahrenheit reaction is about 60%.
According to the above points, it is easy to distinguish from cervical spondylosis. In addition, other examination results can be referred to, including X-ray plain film, MRI and CT examination, etc., generally do not require myelography.
9. Peripheral neuritis
(1) Overview: This disease is caused by poisoning, infection and allergic reaction after infection. It is mainly characterized by symmetry or asymmetry (rare) limb movement, sensory and autonomic dysfunction. Single or multiple, acute infection due to viral infection or low autoimmune function, known as acute multiple radiculitis (Guillain-Barre syndrome).
(2) Identification points: mainly based on the characteristics of the symmetry symptoms of the disease, including:
1 symmetry dyskinesia: usually expressed as the symmetry of the distal extremities of the limbs, flaccid, incomplete sputum, which is different from the asymmetry sputum sputum in cervical spondylosis.
2 Symmetrical sensory disturbance: There may be bilateral symmetry of the upper or lower limbs, such as glove-sock type sensation, and this change is rare in patients with cervical spondylosis.
3 Symmetric autonomic dysfunction: mainly manifested as vasomotor, sweating and nutritional changes in the hands and feet.
According to the above three points, it is not difficult to distinguish from cervical spondylotic myelopathy. In addition, other related examinations such as medical history, X-ray film, MRI and CT can be used.
10. Secondary adhesion vertebral arachnoiditis
(1) Overview: In recent years, the disease has been increasingly increased. In addition to the long-term compression of the spinal cord and spinal nerve roots due to trauma, most of them are due to spinal canal puncture, intraspinal or extraspinal injection, and subarachnoid block. And caused by myelography, etc., therefore, most of them are iatrogenic factors, this disease can be associated with cervical spondylosis, or can exist alone.
(2) Identification points:
1 history: previous history of spinal canal puncture, injection or myelography, especially some of the more irritating contrast agents (currently no longer used for everyone) is more likely to cause.
2 sexual stimulation symptoms: more obvious, especially those with longer course of disease, often manifested as root pain, the range is more extensive, and is persistent, may have remission period, but increased when increasing abdominal pressure.
3 imaging changes: previous iodized oil angiography, on the X-ray film showed a candle tear shadow in the spinal canal, scattered in the root sleeves on both sides, in addition, MRI technology can clearly show the subarachnoid adhesion The extent and extent of the diagnosis are helpful for the identification of patients with cervical spondylotic myelopathy, but many cases are accompanied by both.
11. Tumor
(1) Overview: The tumors described in this section mainly refer to the cervical spinal cord itself and adjacent tumors that can affect the spinal cord. In addition to the extramedullary tumors in the spinal canal, the latter should pay attention to the local metastasis or primary of the cervical vertebrae. Tumors (previously more common, accounting for more than 90%), especially in the early stages of the disease, if not observed, easy to misdiagnosis or missed diagnosis.
(2) Classification of tumors and their identification points:
1 intramedullary tumor: less common, less than one tenth in spinal cord tumors, and the identification of extraspinal lesions (including cervical spondylosis) and extramedullary tumors can refer to Table 3.
In addition to the above-mentioned clinical identification points, X-ray film and cerebrospinal fluid dynamics tests can be referred to. In addition, intramedullary tumors show a spindle-shaped enlargement of the spinal cord during spinal imaging, and are not consistent with the level of the vertebral ganglion; When the external pressure is performed by myelography, the cup is filled with a defect.
2 extramedullary tumors: intraspinal, extramedullary tumors are more common with schwannomas, accounting for almost half of spinal cord tumors, followed by meningioma (10% to 15%) and metastases (8%), etc. Taking schwannomas as an example, the characteristics are summarized as follows:
A. Age: It occurs between 30 and 40 years old, and there is no significant difference in gender.
B. The site of good hair: multiple hairs at the posterior root of the spinal nerve can affect 2 to 3 roots.
C. Symptoms: Slow onset, due to the compensatory effect of spinal cord and spinal nerve roots, the symptoms gradually occur, mainly manifested as root radiation pain, paraspinal paralysis and affected segmental reflex and muscle strength changes.
D. Diagnosis: In addition to the above characteristics, it is generally confirmed by MRI, CT or myelography.
3 spinal hemangioma: about 5% of spinal cord tumors, in fact, most of them belong to spinal vascular malformations, because of its wide range of lesions, varying degrees of severity, so the clinical symptoms vary widely, from only mild symptoms to complete paralysis The performance is different. The latter mainly causes pathological circulation or thrombosis due to hemodynamic changes in the spinal cord, resulting in softening of the spinal cord due to severe ischemia (post-fibrosis).
The disease is not easy to diagnose early, and patients with transient radicular pain should pay attention to whether it is the disease. Typical cases can be diagnosed by DSA or general myelography and spinal angiography. Atypical cases are often diagnosed during surgery.
The identification of this disease and cervical spondylotic myelopathy, in addition to DSA and other imaging techniques, can still be based on the diagnosis of cervical spondylosis itself, such as the two, the prognosis is poor.
12. cervical spinal cord hyperextension injury
(1) Overview: cervical spinal cord hyperextension injury, also known as central spinal cord syndrome, is a type of cervical trauma, which is easily confused with the anterior central artery syndrome caused by flexion injury on the basis of cervical spondylosis. Most of the former need to adopt conservative therapy first, while the latter needs early surgery, so it is of practical significance to distinguish between the two.
(2) Identification points:
1Injury mechanism: Both of them occur after head and neck trauma. Most of the overextension injuries are caused by the sudden braking of high-speed vehicles. Due to the inertia, the passenger's face, jaw and ankle are hit by the front. The head and neck are stretched backwards; at this time, the elongated spinal cord (the spinal canal becomes relatively narrow) is easily inserted into the ligamentum flavum of the anterior process and the anterior bone fibrous wall, causing the spinal cord The lesion around the central canal, and the patients with anterior central artery syndrome of the spinal cord are mostly based on the spur of the posterior margin of the vertebral body or the nucleus pulposus. They suddenly suffer from the violence of the head and neck flexion, so that the front of the spinal cord is hit by the bone or cartilage. Sexually induced pressure, causing paralysis and stenosis of the anterior central artery of the spinal cord, and symptoms of blood supply insufficiency.
2 dyskinesia: Because the pathological changes of hyperextension injury are located around the central canal of the spinal cord, the first part of the nerve conduction bundle involving the upper limb first appears in the upper limb paralysis, or the upper limb is heavy, the lower extremity is light, especially the hand is most obvious, while the spinal cord The patients with anterior central artery syndrome are completely opposite. The lower limbs are lower and the upper limbs are lighter.
3 sensory disorder: patients with anterior central artery syndrome have less sensory function, while patients with hyperextension injury have obvious symptoms, and there may be a phenomenon of sensory separation, that is, temperature and pain disappear, while position and deep feeling exist. This is mainly Because the lesion is located near the central tube.
4 imaging changes: X-ray plain film on the two have significant differences, over-extension injury in the lateral observation can be found in the front of the intervertebral space is widened, and the anterior shadow of the vertebral body is significantly widened, more than the normal value 1 More than double, and the patients with anterior central artery syndrome of the spinal cord are mostly on the basis of the formation of bone spurs, so not only the presence of osteophytes, but also the spinal canal is generally narrow (the wide spinal canal is not easy to onset).
5 Others: It is still possible to refer to the presence or absence of soft tissue injury in the face or the back of the head, as well as the age and medical history of the patient, and generally do not require myelography.
Summarize the above points and distinguish the two.
13. Other diseases: cervical discitis, cervical vertebral osteomyelitis or other lesions that cause spinal cord symptoms should be noted.
