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Compression of the spinal cord
Last reviewed: 23.04.2024
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Various causes lead to compression of the spinal cord, causing segmental sensory and motor deficits, changes in reflexes and disruption of sphincters.
Diagnosis of the disease is confirmed on an MRI.
The treatment is aimed at eliminating the compression.
Causes of the compression of the spinal cord
In most cases, the source of compression is located outside the spinal cord (extramedullary), less often - within the spinal cord (intramedullary). Compression can be acute, subacute and chronic.
Acute compression of the spinal cord develops in a few hours. It usually occurs with trauma (compression fracture of the vertebrae with displacement of bone fragments, significant damage to bones or ligaments with the development of hematoma, subluxation or dislocation of vertebrae) or accompanies spontaneous epidural hematoma. Acute compression may develop after subacute or chronic, especially if caused by an abscess or swelling.
Subacute compression of the spinal cord develops in days or weeks. Common causes: metastatic extramedullary tumor, subdural or epidural abscess or hematoma, rupture of the intervertebral disc at the cervical or (rarely) thoracic level.
Chronic compression of the spinal cord develops over months or years. Causes: Bone or cartilaginous protrusion into the vertebral canal at the cervical, thoracic or lumbar level (for example, osteophytes or spondylosis, especially in the background of the congenital narrow spinal canal, more often at the lumbar level), arteriovenous malformations, intramedullar and slowly growing extramedullary tumors.
Subluxation in the atlanto-joint or other violations of craniocervical junction can cause acute, subacute or chronic compression of the spinal cord.
The formations that squeeze the spinal cord can have the same effect on the nerve roots or, in rare cases, disrupt the blood supply to the spinal cord, leading to a heart attack.
Symptoms of the compression of the spinal cord
Acute or subacute compression of the spinal cord causes segmental deficiency, paraparesis or tetraparesis, hyperreflexia, extensor plantar reflexes, loss of sphincter tone (impairment of pelvic organs), with loss of sensitivity. Subacute and chronic compression can debut with local back pain, often irradiating in the innervation zone of the nerve root (radicular pain), or with hyperreflexia and loss of sensitivity. Initially, the sensitivity may fall in the sacral segments. A sudden complete loss of function is possible with a spinal cord infarction. At a metastasis, an abscess or a hematoma percussion of spinous processes is painful.
Intramedullary formations more often cause difficult localized burning, rather than radicular pain, sensitivity is preserved, spastic paresis develops.
Diagnostics of the compression of the spinal cord
Compression of the spinal cord involves spinal or radicular pain with motor, sensory and reflex deficiency, especially at the segmental level. If it is impossible to perform MRI, CT-myelography is performed.
By means of lumbar puncture, a nonionic low osmolar radioactive preparation is administered which, advancing in the cranial direction, contrasts the lower level of the complete blockage of the spinal canal. The radioactive preparation is then taken from above by means of a cervical puncture and the rostral level of the block is determined. Radiography of the spine is useful for the rapid detection of bone pathology (fracture, dislocation, subluxation) with trauma.
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Treatment of the compression of the spinal cord
Treatment is aimed at reducing pressure on the spinal cord. Partial and recent total loss of function can be reversible (complete loss is rare). Therefore, with acute compression, diagnosis and treatment do not tolerate delay.
If compression is caused by a tumor, immediately inject dexamethasone 100 mg intravenously, then 25 mg every 6 hours and urgently begin surgical treatment or radiation therapy. If, despite conservative treatment, the neurological deficit is increasing, an operation is indicated. Surgical treatment is also indicated in cases of biopsy, spinal instability, relapse after radiotherapy, and if an abscess, subdural or epidural hematoma is suspected.