Manifestations and therapy of vertebrogenic myelopathy

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Compressive myelopathy is a very serious complication in diseases of the nervous system; it is based on compression of the spinal cord by various formations: disc herniation, hematoma, tumor, formation of bone fragments due to any injury.

The main symptom of the disease is loss of sensory and motor function. In addition, the functioning of internal organs is disrupted. To diagnose this disease, computed tomography, as well as myelography and radiography are performed. Spinal cord compression is treated surgically.

Causes

The development of myelopathy is facilitated by many factors that have been studied by doctors for a long time. According to experts, the pathologies that provoke the disease are formed outside the spinal cord. The main provocateurs of the disease are degenerative deformities of the spinal column:

• presence of osteochondrosis;
• diagnosing spondyloarthrosis;
• manifestation of spondylosis;
• ivolutive spondylolisthesis.

The second reason for detecting myelopathy is injury:

• dislocation, subluxation of vertebral fragments;
• spinal column fracture;
• compression injury of the spine.

Cardiovascular diseases negatively affect the functioning of the spinal cord. Doctors diagnose myelopathy in the presence of thrombosis of spinal vessels and atherosclerosis.

Changes in the structure of the spine contribute to the formation of chronic neurological pathologies. Benign and malignant neoplasms in the vertebral area, metabolic disorders in diabetes mellitus, and dysproteinemia are also factors in the development of myelopathy. Radioactive or toxic poisoning often leads to deformation of the spinal cord.

In medical practice, myelopathy, which affects the substances of the spinal cord, is less common. The source of the disease can be:

• spinal cord injury;
• infectious diseases;
• neoplasms in the spinal cord;
• hematomyelia.

It has been proven that demyelination is not the last place in identifying the disease. It may have a hereditary suggestion in Roussy-Lévy syndrome, Refsum's disease. The acquired form manifests itself in multiple sclerosis. Cases of the development of myelopathy due to complications of lumbar puncture have been recorded. Illiterate manipulation can harm the productive functioning of the brain.

In the list of pathogenetic mechanisms for the development of the disease, compression ranks high. Subspecialty specialists record compression due to intervertebral hernia, fracture fragments, tumor, displaced spine, and osteophytes. Pathological processes compress the spinal cord and compress spinal vessels, causing hypoxia and malnutrition. Afterwards, degeneration and death of the nerve endings of the affected spinal segment occurs.

It is important to know that pathological deformations form and develop in stages with increasing compression. The end result is a loss of neuron function, and the impulses passing through it are blocked and migrate along the spinal cord pathways.

According to statistics, the disease is often recorded in the lumbar region. It may be a consequence of vertebral displacement, osteochondrosis, spondyloarthrosis. It is assumed that among the main factors of pathology may be:

• contact with infected people;
• infectious diseases of acute or chronic origin;
• frequent injuries in the form of falls or bruises;
• extreme sports;
• insect bites, especially ticks;
• hereditary genesis;
• harmful occupational factors;
• identified blood clotting disorders.

You should know that the disease can attack people of any age, regardless of gender. Young patients most often suffer from post-traumatic myelopathy.

How to avoid myelopathy of the thoracic spine

Since the development of myelopathy in the thoracic spine can be triggered by various factors, there is no single method to prevent the disease. But you can still reduce the likelihood of this disease occurring if you follow some simple rules:

• Eat right - the human body must constantly receive all the necessary minerals and vitamins; B, E and calcium play a particularly important role for the spine.
• Active lifestyle - physical activity within reasonable limits helps keep muscle tissue and joints in good shape, so doing gymnastics, exercises and other sports activities is a good prevention of spinal cord diseases.
• Elimination of excessive loads - during heavy loads, vertebral displacement or other damage can occur that can cause myelopathy. Therefore, it is better to avoid overstraining the spine and wear a corset before heavy physical activity.
• Timely treatment of chronic and infectious diseases - one of the main causes of myelopathy is diseases affecting the spinal cord, and in order to prevent such complications, they need to be treated in a timely manner.

The main danger of myelopathy is the fact that it can arise through a variety of factors, which are not always possible to keep track of. If the first signs of this disease occur, you must immediately contact the clinic for examination and, if necessary, an optimal course of therapy.

Classification of myelopathy

The disease is classified according to the etiological principle. Degenerative disorders in the vertebrae are classified as a spondylogenic type of disease. With chronic changes in spinal blood flow, an ischemic, atherosclerotic, vascular form of the disease is diagnosed.

After significant damage to the spinal cord in the form of a concussion or bruise, doctors diagnose post-traumatic myelopathy. This category includes compression hematomas, confusion of vertebrae, and fractures of fragments of the spinal column.

Myelopathy of the carcinomatous type manifests itself during the period of paraneoplastic damage to the central nervous system, oncological diseases:

• leukemia;
• lymphoma;
• malignant tumors in the lungs;
• lymphogranulomatosis.

An infectious type of pathology is diagnosed in VIL infected patients. Patients with syphilis are at risk. In childhood, the disease develops against the background of a severe enterovirus infection.

With toxic damage to the central nervous system, toxic myelopathy develops. It is often diagnosed with diphtheria.

Cases have been recorded when the disease activates its effects after exposure to radiation. The radiation form of the disease appears in patients after radiation exposure for oncology.

Against the background of endocrine and metabolic disorders, the metabolic form of the disease can manifest itself.

Prognosis and prevention of discogenic myelopathy

Compression of the spinal cord causes serious harm to the body, as it leads to the death of neurons, which causes neurological deficits in the sensory and motor areas. That is why a favorable prognosis for patients seems possible only if the disease was diagnosed at its early stage. Adequate surgical treatment and further rehabilitation of patients help to completely restore impaired motor functions and return to their normal lifestyle.

If you perform an operation at a stage when the disease has already worsened, then in this way it will only be possible to stop its further progression. However, the neurological disorders formed during this time will acquire a persistent and irreversible effect, which will most likely cause the patient’s disability.

Since the disease can be caused by various reasons, it is difficult to name any clear preventive measures that will help prevent it. However, there are several rules that, if followed, will help maintain normal functioning of the body and reduce the risk of discogenic myelopathy.

First of all, you need to constantly monitor your posture, lead an active lifestyle and exercise daily. You should also adhere to the principles of a healthy and balanced diet and get rid of bad habits. The correct choice of bed plays an important role in disease prevention. It is advisable to sleep on a fairly hard surface, and also choose a pillow on which your head will not hang or bend.

Symptoms

Symptoms of myelopathy manifest themselves in different ways. Doctors record the main clinical manifestations:

• spinal cord injury is accompanied by complete or partial immobility of the arms and lower extremities;
• the tone of muscle fragments increases;
• reflexes are strengthened;
• there is a problem when urinating;
• fecal incontinence is observed;
• tissue sensitivity increases or decreases.

Subspecialty specialists claim that chronic vertebrogenic myelopathy has symptoms of the underlying disease. The patient is attacked by pain attacks in the spinal column, the intensity of which depends on the severity of the course. Many patients experience a decrease in vertebral mobility. When intoxicated, patients are prone to fatigue. Body temperature increases significantly, fever is observed. Such signs indicate an infectious type of myelopathy. When the spinal cord is damaged, the peripheral nerves become unable to function properly.

Cervical

When the disease activates, neurologists are obliged to explain to victims in detail what myelopathy is, paying attention to complications and prognosis of the pathology without timely therapeutic measures. Cervical myelopathy, according to experts, is a severe injury. Even partial seizure of the spinal cord by the disease can lead to unexpected complications. In doctoral practice, deaths occur.

Cervical myelopathy manifests itself with clinical signs of various etiologies. Symptoms vary with weak and strong manifestations, which intensify their effect against the background of the cause of the damage. Over the years of productive medical practice, experts have identified the main symptoms:

• At the initial stage, cervical myelopathy is characterized by radicular disorders that are located in the arm area. Patients are diagnosed with long-term osteochondrosis without significant improvements with therapy. Cervical myelopathy of the spondylogenic form is characterized by burning pain that spreads to the internal and external areas of the upper extremities. The patient is in a weakened condition. Muscle forces stop working at full strength.
• When the disease is involved in a pathological process with damage to the substance of the spinal cord, striking changes in sensitivity occur. Cervical myelopathy impairs tactile sensitivity of the lower cervical areas. Painful attacks become more intense. Muscle mass decreases, provoking a symmetrical or unilateral decrease in the strength functions of the limbs.
• Cervical myelopathy, damaging the spinal cord, leads to loss of sensitivity in the skin tissues of the torso, arms, and legs. A severe form can provoke loss of motor function of the human body and limbs.

It is important to know that if the upper neck area is completely or partially damaged, a person can die instantly. Doctors warn that cervical myelopathy cannot await therapeutic measures for a long time. Treatment should begin at the slightest sign of pathology development. The neglected form puts human life at risk.

Chest

The development of the disease in the thoracic segment is recorded by doctors less often than cervical myelopathy. The causes of not very common pathologies are the strengthening properties of the chest. The main focus of the formation of the disease lies in the vessels, which are susceptible to damage due to the influence of provoking factors.

The main clinical manifestations are:

• Painful attacks. An unpleasant burning sensation is localized in the area of ​​the lateral surface of the sternum. The pain intensifies during movements, while inhaling and exhaling. Painful attacks occur as intercostal neuralgia.
• When tissue fragments of the spinal cord are damaged, sensory disturbances appear and mobility suffers. It should be understood that the thoracic region has a large extent, therefore manifestations in the form of tetraparesis (as well as cervical myelopathy), paraparesis are provoked, in which the lower limbs and the lower half of the human body are involved in the process.

Symptoms are clearly manifested in severe injuries. The patient loses mobility partially or completely, and there is no sensory function. Doctors have noticed that the chest form of pathology rarely leads to unpredictable consequences. With proper therapy, the prognosis is favorable.

Lumbar

The clinical picture of damage to the lumbar spine is similar to the vertebrogenic form of the disease. The main cause of the complication is intervertebral hernia, a compression form of injury. The patient, when collecting anamnesis, describes pain that burns and shoots. Their location is the lower back. Often pain attacks migrate to the buttocks, moving to the lower extremities.

With paresis of the arms and legs, the situation becomes clearer after determining the level of damage. If the upper lumbar region is affected, disturbances are observed in the anterior or lateral zone of the lower limb. If the lower area is damaged, the back side suffers.

Changes in motor function have the form of paraparesis. Muscle strength and volume of leg muscles decrease. Doctors often observe pelvic disorders characterized by incontinence or acute urinary retention and fecal discharge. In men, the pathology most often provokes impotence.

Myelopathy, the treatment of which is aimed at complex therapy, has a favorable prognosis. If there is no severe damage, spinal myelopathy can be corrected.

Symptoms of discogenic myelopathy

The symptoms of the disease are caused by a gradually worsening deficit of the sensory and motor areas. Motor disorders are manifested by symptoms such as paresis (decreased muscle strength), impaired tendon reflexes, and degenerative changes in muscle tone.

As for the sensory disorders characteristic of discogenic myelopathy, these include a decrease in sensitivity, as well as the appearance of paresthesia. If we talk about the severity of motor and sensory disorders, the former manifest themselves more clearly and acutely.

At the very beginning of the development of the disease, mainly unilateral symptoms appear. Namely, the patient complains of disturbances in the side where the spinal cord was affected. However, over time, such violations also affect the other side. Less common symptoms of the disease are sciatica and problems with urination.

It is worth noting that the symptoms of the disease appear depending on its location. In particular, lumbar discogenic myelopathy is accompanied by leg paresis, muscle atrophy, sensory ataxia, urinary retention, and absence of knee reflexes. Lameness syndrome is sometimes observed.

Cervical myelopathy is characterized by spastic paresis in the legs and arms and muscle atrophy in the arms. The clinical picture of the pathology is also characterized by paresthesia in the arms, decreased deep sensitivity in the arms, loss of sensation in the legs and torso. Often, cervical myelography develops in parallel with vertebral artery syndrome.

Diagnosis of myelopathy

Diagnostic measures are carried out by a neurologist. Consultation with other specialized doctors is not excluded:

• vertebrologist;
• oncologist;
• phthisiatrician;
• venereologist.

A series of measures is aimed at ensuring the absence of another CNS disease with a similar clinical picture. The doctor’s main task is to identify the cause of the development of the pathology that provoked dystrophic defects of the spinal cord.

Neurology requires a consultation with a doctor, which begins with taking an anamnesis. A specialist with a narrow focus studies the medical history, paying special attention to the individuality of the body, previous illnesses of a different nature. The patient's task is to provide disclosed information about symptoms, their duration and severity.

The next stage of the examination includes:

• blood collection for general and biochemical analysis;
• X-ray of the spinal column in several projections;
• MRI of the vertebra;
• electromyography;
• electroneurography.

Additionally, specialist experts prescribe evoked potential studies. Doctors often recommend not to refuse MRI, CT scans of the spinal cord, and lumbar puncture. If it is impossible to perform an MRI for a number of reasons, it is recommended to perform myelography and discography.

With minimal suspicion of infectious myelopathy, the patient should undergo a blood test for sterility. PCR analysis and RPR test are mandatory. An assistant for proper diagnosis is cerebrospinal fluid culture.

Diagnostics

Vertebrogenic myelopathy with lower paraparesis is diagnosed by several methods, but several diagnostic procedures are required to make an accurate diagnosis. For example, it is not recommended to use radiography, since this method will not accurately determine the condition of the spine.

MRI should be considered the most informative diagnostic method, and if it is not possible, CT should be performed.

To confirm or refute the presence of tumors, as well as to understand whether there is a narrowing of the spinal canal, it is useful to perform myelography.

Treatment of myelopathy

Treatment of the disease is individual for each patient. Treatment methods are developed by an experienced doctor based on the examination results. It is important to understand the reason for the development of the disease in order to stop not only the outbreak and the symptoms that have appeared, but also the possibility of the formation of concomitant pathologies.

Therapeutic measures for spinal structures and the lumbosacral region, which are accompanied by neurological manifestations, consist of taking medications and conservative methods of eliminating the problem. Folk remedies can be auxiliary medications. In severe cases, surgical procedures cannot be avoided.

Treatment

Acute and subacute myelopathy requires immediate treatment. The goal of such treatment is to quickly remove the spinal element from which compression and damage occurs. It helps reduce damage to nerve pathways. Chronic compression requires immediate intervention. Treatment depends on the period when the compression occurred, as well as its magnitude.

Typically, for a chronic disease caused by osteochondrosis, a two-stage treatment regimen is proposed. Initially, a course of therapy is prescribed. This stage includes taking vitamins, anti-inflammatory drugs, and other medications that repair tissue.

If these methods do not help, then surgical treatment cannot be avoided. The following methods can be carried out:

• removal of vertebral hernia;
• laminectomy;
• facetectomy;
• disk replacement.

The cause of compression myelopathy depends on this. The most important role in treatment is played by constant therapy, that is, annual rehabilitation courses in special medical institutions. Doctors prescribe daily therapeutic exercises for patients, which were written by a physical therapy doctor.

Conservative therapy

Treatment with conservative methods includes procedures that help restore the functions of nerve impulses to full strength, reduce pain thresholds, and correct vertebral fragments.

After restoration of fragments of the spinal column, patients must undergo a rehabilitation period. It is important to systematically perform the therapeutic exercises developed by the instructor. Movements help to move muscle structures and bring them back to normal. During exercise therapy, you should strictly follow the technique so as not to harm the affected areas. You need to move smoothly, avoiding abruptness and prolonged physical exertion.

Physiotherapy is prescribed based on the results of a re-examination after treatment. You should not refuse a course of therapeutic massage. The effectiveness of the result depends on the doctor’s instructions. Following the advice and recommendations of a qualified specialist, after a short time the patient will feel significant relief and his overall health will improve.

How to get rid

Treatment can be both conservative (at the very beginning) and surgical when other methods fail. The patient is recommended to wear a Schanz collar throughout the therapy, but this should only be done for a few hours a day. You also need to undergo a full course of physical therapy and start doing gymnastics, which will help strengthen your neck muscles. However, this can be done outside the period of exacerbation.

Drug therapy is carried out using drugs from the NSAID group, and these are ortofen, diclofenac, and many others - they are the main drugs for treatment. Muscle relaxants may also be used. They can only be used in a hospital setting, as they have many contraindications and side effects. Their appointment is necessary to relieve tension in muscle tissue, which causes severe pain.

Surgery is performed only when drug treatment fails. Moreover, this could be the removal of disks or the installation of artificial ones. Other methods may be used, but it all depends on what the patient's diagnosis is and what complications are already present.

Since the cause of vertebrogenic myelopathy is most often trauma, spinal surgery is performed within the first few hours after surgery. But even this does not provide a complete guarantee that this condition will not develop in a person, especially since it is usually chronic and cannot be treated.

Complications from this pathology can be very different, but the most dangerous are paresis and paralysis, which occur all the way below the site of injury. Sometimes the patient may need a long period of rehabilitation, but full recovery may not occur.

Drug treatment

Doctors resort to medication therapy when identifying myelopathy caused by infectious pathological processes. It is important to know that therapy will require a long time, patience and taking all medications prescribed by the doctor. The main task of the doctor is to overcome the initial infection, which acts as a focus of myelopathy.

Patients are prescribed strong antibacterial agents. It is important to follow the course of therapy without refusing to take medications when you feel the first improvements in your general condition. The dosage, time of administration, and duration of drug treatment are determined based on the results of the examination.

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Medications with antipyretic and anti-inflammatory effects help prevent the development of the inflammatory process. Painkillers can relieve pain.

Surgical treatment

Surgical procedures are indicated for the removal of tumors or intervertebral hernia. Operating processes are carried out by qualified specialists, guaranteeing the patient a positive result.

The operation takes place in the absence of contraindications. The patient is under general anesthesia. The doctor makes an incision in the area where the pathology is located. Next, resection of the tumor is performed, which affects the development of myelopathy. The postoperative period is important. The patient is prescribed medication, which is carried out under the strict supervision of hospital doctors. A successful manipulation guarantees a quick recovery.