Myelopathy: symptoms and treatment

Myelopathy is a term that characterizes a group of non-inflammatory diseases, for which a dystrophic spinal cord injury is characteristic. More often, clinicians diagnose cervical myelopathy, which begins to progress against a background of spondylosis or osteochondrosis, as well as myelopathy of the thoracic spine.



Etiology

The main etiological factors of myelopathy of the spine:


  • spondylarthrosis;
  • osteochondrosis;
  • vertebral fracture in a specific spine;
  • Atherosclerosis
  • vertebral dislocation
  • Tuberculosis
  • defects in the development of the spine;
  • toxic and radiation damage to the human body
  • spine osteomyelitis
  • metabolic disorder
  • tumors of benign or malignant nature located in close proximity to the spine
  • demyelination
  • vertebral-spinal trauma
  • Hematomyelia
  • Spinal cord tumor.

Views


  1. cervical myelopathy. It is also called the cervical. This form of pathology begins to progress due to congenital stenosis of the vertebral canal, trauma of varying severity, craniovertebral anomaly, compression of the spinal cord with a tumor-like formation. In addition, cervical myelopathy occurs against cirrhosis, Lyme disease, insufficient intake of vitamins B and E in the body;
  2. Atherosclerotic form. It begins to progress after the accumulation of cholesterol plaques on the walls of blood vessels that supply blood to the spinal cord. The following pathologies contribute to this: heart disease, systemic atherosclerosis, hereditary metabolic disorder
  3. vertebrogenic myelopathy. Progresses against the background of osteochondrosis of the spine, intervertebral hernias. Occurs in 2 clinical forms — acute and chronic. An acute form is caused by a trauma. More often it is diagnosed in car accidents. While the car with the driver is colliding with another car, there is a specific «whiplash». The neck and head are sharply shifted forward, and then back. As a result, the vertebrae or intervertebral discs are displaced in the cervical spine.

The chronic form of pathology develops in the presence of a long-term progressive osteochondrosis (when osteophytes actively grow). These specific formations compress the spinal cord in any part of the spine (usually in the cervical and thoracic):


  • Radiation form. Progresses after radiotherapy (in the presence of malignant lesions)
  • toxic form. Develops after prolonged exposure to toxic active substances on the central nervous system
  • infectious form. Often diagnosed against HIV, Lyme disease and others;
  • carcinomatous form. Develops in leukemia, lymphoma, lymphogranulomatosis, oncological pathologies
  • demyelinating form.

Symptoms

Symptoms of myelopathy directly depend on the cause of the onset of the disease, as well as on the form of the process. The first symptom of pathology is a pain syndrome in the affected spine. After the clinical picture is supplemented by the following symptoms:


  1. the strength of the muscles in the localization area of ​​the lesion is reduced, up to the development of paralysis
  2. reduced skin sensitivity in the affected area
  3. a person is difficult to perform arbitrary movements for him;
  4. If the spinal cord was injured in the lumbar region, then the functioning of the internal organs may be malfunctioning — involuntary discharge of feces or urine, constipation

Symptoms of cervical damage:


  • loss of skin sensitivity of the hands and neck
  • spasms or twitching of the arm muscles are observed
  • severe pain in the neck, shoulder area.

Symptoms of myelopathy of the thoracic spine:


  1. weakness of the hand;
  2. pain in the heart area, similar in intensity to pain in the infarction
  3. Decrease in sensitivity;
  4. pain syndrome in the region of the ribs. This symptom tends to increase at the time of human inclinations in different directions
  5. a person observes that he has a feeling of tingling or twitching in the muscles of the back, sternum.

Diagnostics

Myelopathy is diagnosed by a neurologist. After visual inspection, the specialist can additionally assign instrumental and laboratory examination methods.

Instrumental:


  • densitometry
  • Radiographic examination
  • CT;
  • MRI.

Lab:


  1. biopsy;
  2. Taking a cerebrospinal fluid for subsequent sowing.

Treatment

The choice of a method of treating myelopathy depends on the cause of its progression and on the form. The main goal — to cure the root cause of the disease, as well as to eliminate unpleasant symptoms.

Myelopathy of the compression type is treated only after the compression of the vertebrae has been eliminated. It is carried out:


  • drainage of cystic structures
  • removal of the formed hematoma
  • removing the wedge of Urban.

Treatment of spinal canal narrowing:


  1. Fastectomy
  2. Laminectomy
  3. microdiscectomy.

If ischemic myelopathy has been diagnosed, then the specialists first eliminate the cause of vascular compression. The treatment plan includes vasodilating and antispasmodics:





  • Cavinton
  • no-shpa;
  • papaverine (helps to calm spasm and reduce the appearance of unpleasant symptoms)
  • Compline.

Medication and physiotherapy:


  1. metabolites;
  2. Neuroprotectors
  3. Vitaminotherapy;
  4. paraffin therapy;
  5. diathermy and the like.

To normalize the motor activity, as well as to stop the progression of various dangerous complications, appoint:


  • exercise therapy
  • Hydrotherapy
  • massage;
  • reflexology;
  • Proeryrin electrophoresis
  • CMT paretic muscles



  • electrical stimulation