spinal cord compression
Introduction
Introduction When the fracture is displaced, the broken bone piece and the broken intervertebral disc can be directly compressed into the spinal canal, and the pleated yellow ligament and the rapidly formed hematoma can also compress the spinal cord, so that the spinal cord produces a series of pathological changes of spinal cord injury.
Cause
Cause
Spinal cord compression occurs after hepatocellular carcinoma has bone metastases. When the fracture is displaced, the broken bone piece and the broken intervertebral disc can be directly pressed into the spinal canal, and the pleated yellow ligament and the rapidly formed hematoma can also compress the spinal cord and compress the spinal cord.
Cause:
1. Tumor.
2. Inflammation.
3. Trauma.
4. Congenital diseases.
5. Spinal cord bleeding.
6. Disc herniation.
7. Post-ligament calcification and hypertrophy of the ligamentum flavum.
Examine
an examination
Related inspection
Spinal MRI
Primary intraspinal tumors have pathological manifestations of spinal cord compression, and the main factors affecting the pathological changes of spinal cord compression are:
1. It is related to the location of tumor compression and the nature of nerve tissue structure:
The tolerance of various spinal nerve tissues to pressure is different: the pain fibers are finer (less than 2 m in diameter), and the fine fibers are more tolerant than the crude fibers after compression, and the recovery is faster after the compression is released. In general, at the beginning of compression, the nerve root is pulled, the spinal cord is displaced, and then deformed under pressure, and finally the spinal cord is degenerated, gradually causing neurological dysfunction of the tissue.
2, the impact of tumor on the blood circulation of the spinal cord: venous dilatation, blood stasis and edema after venous compression; after the arteries are compressed, the blood supply in the dominating area is insufficient, hypoxia and dystrophic, causing spinal cord degeneration and softening, and finally causing spinal cord necrosis. In terms of tolerance to ischemia, gray matter is larger than white matter, and fine nerve fibers are larger than coarse nerve fibers. It has been reported that the dorsal surface of the spinal cord is blue in the operation, the nourishing artery is enlarged, and the drainage vein is significantly missing, but a small amount of small nourishing artery can be seen under the microscope. The course of intraspinal tumors is generally more than 1 year. The shortest symptoms were reported for 17 days and the longest for 12 years. The average duration of intramedullary tumor was 11.6 months, and the average duration of extramedullary tumor was 19.2 months.
3. The hardness of the tumor is closely related to the degree of damage to the spinal cord: soft tumors, especially those with slow growth, allow the spinal cord to have sufficient time to adjust its blood circulation, develop slowly, have mild symptoms, and recover spinal cord function after surgery. And perfect. Hard tumors, even if they are small in size, because they are easy to embed in the spinal cord, any spinal activity can cause tumor contusion and gliosis, and most of the postoperative recovery is not ideal.
4. It is related to the growth mode of tumor and its growth rate: some intramedullary tumors mainly have dilated growth, and some mainly invasive growth. The latter caused greater damage to the spinal cord. Tumor growth is slow, even if the spinal cord is stressed, because the spinal cord is still compensatory, the symptoms can be mild; on the contrary, faster growing tumors, especially malignant tumors, can easily cause acute complete traverse damage of the spinal cord, requiring emergency surgery Relieving spinal cord compression, even if it is 1 to 2 hours of delay, often has serious consequences.
Diagnosis
Differential diagnosis
Spinal thalamic bundle compression: When the spinal cord is compressed, the dyskinesia occurs before the sensory disturbance. In addition to the compression of the spinal cord tissue, it may be accompanied by blood circulation disorders, cerebrospinal fluid dynamics, and complications such as inflammation and adhesion. Therefore, clinical performance presents diversity and complexity. The spinal cord and spinal nerve roots in the plane of the primary intraspinal tumor are compressed.
Spinal cord compression: refers to a group of diseases caused by lesions of various natures that cause compression of the spinal cord, spinal nerve roots, and their supply vessels.
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.
(2) Feeling disorder. The plane of sensory disturbance often has a great reference value for the location of lesions.
(3) Abnormal reflection.
(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.
