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Myelopathy – what is it

General information

The spinal cord is the fundamental “axis” of our nervous system, through which the brain communicates with the rest of the body. That is why myelopathy can lead to the most serious consequences up to complete loss of working ability.

Moreover, it is impossible to clearly outline the “risk group”, since, due to the diversity of the reasons for its occurrence, both a child, an active and athletic youth, and middle-aged and older people can get sick. Here are some age categories of patients:

  • children who have had an enterovirus infection;
  • young people (15 to 35 years old) who received spinal cord injury;
  • people of middle (30-50 years) age with a primary tumor;
  • elderly (from 55 years old) people with degenerative changes in the spine due to old recurring injuries; most often, those whose professions are associated with physical activity.

Depending on the diseases that have become the primary cause of the development of myelopathy, some other groups can be identified, for example, cancer patients or people with changes in bone tissue due to arthrosis and osteoporosis.

The main reasons can be divided into several groups:

Such a wide scatter of possible factors causing myelopathy affects the ambiguity of the classification of the disease.

Classification

At the site of spinal cord injury, the disease is divided into myelopathy of the cervical, thoracic, and lumbosacral spine.

According to the etiology (causes) myelopathy secrete a much larger number of options. And in this case, the disease gets a double name, where the first is the explanatory term. The main types of the disease include:

  • vertebrogenic (spondylogenic, discogenic, cervical myelopathy) – caused by compression (compression) of the spinal cord under mechanical action of spinal deformities caused by osteochondrosis, spondylarthrosis, herniated intervertebral discs and other vertebral forms;
  • atherosclerotic (dyscirculatory, ischemic) – manifests itself in violation of blood circulation and various pathologies of blood vessels;
  • carcinomatous – is a manifestation of CNS damage in cancer;
  • post-traumatic – it includes both the injury of the spinal cord itself (for example, contusion, concussion, damage during spinal puncture), and compression effects on it as a result of violations of the integrity of the spinal column;
  • metabolic – occurs as a complication of metabolic and endocrine disorders of the body;
  • postradiation (radiation) – caused by radiation exposure and most often is a consequence of radiation therapy;
  • infectious – may occur in various infectious diseases (for example, in HIV, neurosyphilis, or enterovirus infection);
  • toxic (intoxication) – occurs in case of a poisonous effect on the central nervous system (CNS), for example, in diphtheria;
  • dimyelinating – due to hereditary factors or multiple sclerosis.

There are really many options for spinal cord injury, so in any of these cases of injuries or illnesses, it is worth checking for possible myelopathy.

Independently determine this disease is not so simple. In the early stages, especially in cases of primary disease myelopathy, accompanied by severe pain, the damage to the spinal cord is almost impossible to notice.

A pronounced symptom complex is characteristic of higher levels of myelopathy. And the most common signs of it, regardless of etiology, are:

  • back pain, often irradiating (radiating) in a limb, ribs or lower back, which can be perceived as heart or kidney pain;
  • muscular weakness of varying degrees;
  • reducing the sensitivity of the skin (any – tactile, pain, temperature, muscle and joint feeling, or all types at once) to complete numbness;
  • impaired motility of voluntary movements – convulsions, paresis, or partial paralysis;
  • manifestation of pelvic dysfunction – the bladder and intestines.

If such symptoms occur, an urgent need to contact a neurologist, because the sooner myelopathy is diagnosed, the greater the chance of cure.

Diagnostics

As in the case of any disease with a complex genesis (origin), the doctor, in the first place, should exclude the possibility of other ailments with similar symptoms. Therefore, in addition to visual inspection with palpation, laboratory and hardware studies are always applied.

Laboratory methods include not only a blood test (total, developed and determining the level of inflammatory proteins), but also the study of cerebrospinal fluid, bone and (or) soft tissue.

As an instrumental examination are used:

  • X-ray (computed x-ray tomography) – to visualize the state of the bones of the spinal column;
  • magnetic resonance imaging – for visual examination of the spinal cord (its compression, deformation), the presence of tumors;
  • electromyography, electroneurography – to assess the level of damage to the central nervous system and peripheral nerves.

Such a diagnostic algorithm makes it possible to most accurately determine the state of the spinal cord.

The effectiveness of treatment of spinal cord myelopathy depends on the degree of brain damage, and on its etiology. That is why, in addition to symptomatic treatment, therapy of the primary disease is obligatory.

For each type of myelopathy, a different course of treatment is indicated, which can be either therapeutic (for intoxication, infectious, carcinomatous, and other forms) or operable (for example, with a compression form). In any case, the treatment should eliminate (or at least mitigate) the influence of the underlying disease on the spinal cord, for which, in conjunction with a neuropathologist, doctors of other necessary specializations act.

But there is a mandatory treatment prescribed for the majority of patients with myelopathy. It includes:

  • vascular therapy, which includes the use of antispasmodic and vasodilator drugs, as well as means that improve the rheological properties and microcirculation of the blood;
  • neuroprotective therapy, restoring the metabolism of the nervous system and reducing its susceptibility to hypoxia;
  • physiotherapy, massage and exercise therapy recommended for chronic (non-acute) myelopathy.

And yet, despite the well-established treatment practices, it is far from being possible in all cases to completely get rid of the disease.

Complications

The situation with myelopathy is complicated by the fact that with some primary diseases that cannot be cured completely, their negative effect on the spinal cord cannot be stopped. Aggravation of the state of the central nervous system (increase in damage to nerve tissue) leads to paraplegia, quadriplegia or full paralysis.

Prevention

Any special methods of prevention is myelopathy does not exist. Generally recommended are normal measures to keep the spine healthy:

  • exercises aimed at the formation of a supporting muscle corset;
  • maintaining a fairly active lifestyle, including a strong load on the spine;
  • correct choice of bed (for example, selection of an orthopedic mattress or equipment of a semi-rigid bed);
  • smoking cessation and fatty foods that reduce the elasticity of blood vessels.

To this is added prevention prevention of diseases that cause the development of myelopathy, which include spinal pathologies, vascular diseases, endocrine and metabolic disorders, infectious lesions, lead poisoning, cyanides and other toxic substances, as well as injury prevention.

Full recovery in the case of the disease depends not only (and even not so much) on the timeliness of its detection, but on the factors causing it. So, compression myelopathy, like post-traumatic, is completely treatable with complete elimination of the causes.

The most unfavorable prognosis of recovery are carcinomatous, post-radiation and demyenilizing myelopathy, in which stop the process of further destruction of nerve tissue is almost impossible.

Other types of myelopathy are difficult to predict. For many of them, a complete cure is unattainable due to the incurability of disease-causes; at best, a stable state can be achieved without deterioration. These include, for example, ischemic or metabolic forms of myelopathy.

With toxic and infectious types of myelopathy, recovery depends on the degree of damage to the spinal cord and ranges from sustained remission at initial levels to complete immobility with the fatal destruction of nervous tissue.

Paraplegia is a severe dysfunction (paralysis) of both lower (lower paraplegia) or upper extremities (upper paraplegia) resulting from injuries.

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