Spinal Cord Compression in the Elderly
Introduction
Introduction to spinal cord compression in the elderly Spinal cord compression refers to compression of the spinal cord or cauda equina and is a common tumor complication. In 1959, Barronw reported that the autopsy rate was about 5%. According to the literature, lung cancer accounts for 16% to 33% of spinal cord compression, which is the most common disease in malignant tumors. Followed by breast cancer, accounting for 12% to 28%. The efficacy of treatment for spinal cord compression is better before irreversible convulsions or incontinence, and should be considered an emergency. basic knowledge The proportion of illness: 0.001% Susceptible people: the elderly Mode of infection: non-infectious Complications: paraplegia
Cause
The cause of spinal cord compression in the elderly
Intraspinal tumor (30%):
Intraspinal tumors include a variety of neoplastic lesions that originate in different tissues of the spinal canal, such as the spinal cord, nerve root meninges, or vertebrae. The incidence of intraspinal tumors in children is significantly lower than that in intracranial tumors. The more common meningioma and neurofibroma in adults are rare in children, and the tumors of embryonic residual tissues (epithelial cysts and dermoid cysts) are more common. Childhood. Intraspinal tumors can occur in any segment of the spine and are primarily characterized by nerve root damage in the plane of the tumor and symptoms and signs of long-beam involvement below this level.
Spinal cord infarction (30%):
The most common tumors that cause spinal cord compression are breast cancer, lung cancer, and lymphoma. Spinal cord infarction is a stroke-like onset. Spinal cord symptoms often peak in a few minutes or hours. The anterior spinal artery syndrome occurs due to different occluded blood supply arteries. It is more common in the middle thoracic or lower thoracic segment. The first symptom is often Root pain or diffuse pain in the corresponding part of the lesion level suddenly occurs, and a slow sputum occurs in a short period of time, and becomes a spastic sputum after the spinal shock period.
Deformation of the vertebral body or destruction of the pedicle (10%):
PathogenesisSpinal cord compression is a space-occupying lesion of the spine or spinal canal. It is more common in epidural metastasis. More than 95% of the extramedullary metastases are often invaded by the vertebral body or pedicle of the spine. The body cancer is compressed in front of the dural cavity, and the tumor progresses to expand backwards to compress the spinal cord or the horse's tail, resulting in nerve damage. Occasionally, the metastatic cancer does not invade the bone and directly invades the epidural space. Some animal experiments have shown that the slow and progressive compression of the spinal cord At the time, even if the spinal cord compression is reduced, the nerve function can be restored even if it is a little late, but the rapid compression of the spinal cord must reduce the pressure in time, and it is expected to recover, incomplete spinal cord compression, and greater hope for recovery of nerve function, such as delay. Treatment is almost impossible to recover; some scholars have shown through animal experiments that angioedema can cause spinal cord damage like cancer, and dexamethasone can temporarily reduce spinal edema and clinical symptoms.
Prevention
Elderly spinal cord compression prevention
Early diagnosis of spinal cord compression, early treatment, can prevent the formation of complications.
Complication
Elderly patients with spinal cord compression complications Complications
The main concurrency is paraplegia.
Symptom
Symptoms of spinal cord compression in the elderly Common symptoms Reflex abnormal anal sphincter relaxation palpebral spinal cord compression mechanical compression ascending skin numbness
Upper extremity, lower extremity or lumbar pain and palsy before the diagnosis of lung cancer accounted for 5.3%, of which 1.5% of the first symptoms occurred, Gibert statistics, the average interval between the diagnosis of lung cancer and spinal cord compression is about 6 Months, while breast cancer can last up to 20 years (average 4 years); the incidence of different cancerous metastases on different segments of the spinal cord is 8% to 38% for cervical spine, 40% to 78% for thoracic vertebrae, and 5 for lumbar vertebrae. %60%; this may be related to the number of vertebral bodies, total volume and blood supply, and the distance between the primary tumor and the spinal cord (Table 3). Once the vertebral body is violated, it easily spreads to the spinal epidural space. Because more than 90% of patients have pain first and are confined to the affected vertebral body, or to the corresponding spinal nerve distribution area, the pain may be aggravated by the activity of the waist and back. If not treated, most patients have pain. Sustained for several days, weeks or even months, followed by limb weakness, ascending sensation and numbness. However, autonomic dysfunction often occurs later. The signs of spinal cord compression include sensitive pain in percussing damaged spinal processes. Straight leg lift test Distribution of the damaged vertebral body, or a nerve root pain can occur; at the same time with the relevant limb weakness.
Examine
Elderly spinal cord compression examination
Cerebrospinal fluid, cytological examination, positive.
About 2/3 of the patients with spinal cord compression have the corresponding site of spinal or tender points, X-ray plain film abnormalities, which may be manifested as changes or deletions of intervertebral disc worms, partial or total vertebral body depression and paravertebral soft tissue mass, regardless of spine X-ray Whether the plain film is normal or not, it is not certain whether there is epidural metastasis. The selective contrast angiography of iodized oil has been widely used, but it can be re-evaluated because it can stimulate the subdural space. Now it is non-irritating and water-soluble. Sexually, absorbable and isotonic 36% meglumine in place of cerebrospinal fluid instead of lipiodol, lumbar puncture injection contrast agent should use 22 or finer needle, and should take less than 2ml of cerebrospinal fluid for protein, sugar quantification And use a special filter for cytological examination to increase the positive rate of tumor cells. If the myelogram shows complete occlusion of the medullary cavity, the conventional lumbar puncture method often makes 85% of patients unable to show the upper boundary of the obstruction, then it must be in the neck 1~ 2 intervertebral puncture injection of 36% meglumine to understand the upper boundary of spinal cord compression; if not for cervical puncture, although it can be substituted for CT examination, but the image is often unclear, if there are conditions for thin-layer CT examination, the image can be compared Clear, due to the waist Puncture can bring complications of nerve injury to patients with 14% complete spinal canal obstruction. Recently, there is no common creative MRI, which is conducive to the diagnosis of intradural or extramedullary or extramedullary lesions. Can be used for radionuclide bone scan, although there are certain false positives, combined with medical history and physical examination is still conducive to the location of spinal lesions.
Diagnosis
Diagnosis and diagnosis of spinal cord compression in the elderly
diagnosis
According to the history of malignant tumors and recent physical activity disorders, spinal pain, ascending skin numbness or dysfunction, and corresponding physical examination, as long as there is alertness to spinal cord compression, further examination of the corresponding site of the spine is necessary. Thin-slice CT or MRI confirmed that it is not very difficult to define spinal compression, especially for those with a history of malignant tumors, such as lung cancer patients, about several months after diagnosis (average of 6 months), breast cancer patients are about After several years of diagnosis (average 4 years, up to 20 years), the above symptoms and signs should be considered. Spinal cord compression should be considered. The relevant part of the examination may be taken. For those without a history of malignant tumors, they should be inquired in detail. History and physical examination, for tumor markers examination and radiography examination, to clarify the diagnosis of primary tumors, such as difficult to confirm the diagnosis, then to seek biopsy pathological diagnosis of spinal lesions, the current tuberculosis has an increasing trend, should still be alert to spinal tuberculosis Treat the disease so as not to delay treatment.
Differential diagnosis
Clinically, it must be differentiated from intraspinal and spinal cord tumors and spinal cord infarction.
