Myelopathy (Spinal Cord Damage) – Causes, Symptoms, TherapyIf damage occurs to the nerve tie in the spinal cord of the cervical (cervical spine) or thoracic spine (thoracic spine), we speak of myelopathy Myelopathy. The word myelopathy is composed of the ancient Greek components "myelon" for spinal cord and "pathos" for disease or damage. Inside the spinal column is the spinal canal. This is where the spinal cord runs as well as the nerve fibers in the lower spine. Between the vertebrae, nerves leave the spinal canal and continue to run into the arms, trunk or legs. If there is a constant or. prere on the spinal cord then the spinal cord tie loses its vitality. Leads in the long run to a death of the nerve tie with loss of function. This can be the case, for example, with herniated discs, spinal canal stenosis, tumors or reduced blood flow. Because the central nerve cells (CNS) in the spinal canal cannot regenerate or multiply, the effects of spinal cord damage remain forever or worsen.
Depending on the cause of the spinal cord damage in the spinal canal, a distinction is made between different forms. The localization of the spinal cord damage is decisive for the symptoms. The question is whether the spinal cord of the cervical spine or the thoracic spine is affected.
Cervical myelopathy (cervical spine C3/4) – The spinal cord is lighter in color.
Frequency of myelopathy – men are affected by twice as often as women
From experience we know: men are affected by the problem of myelopathy twice as often as women. Degenerative changes in the cervical spine preferentially affect middle-aged and elderly people. Half of all people over the age of 50. The majority of people over the age of 65 show signs of cervical myelopathy, and three quarters of all people over the age of 65 show signs of cervical myelopathy.
Possibly of interest to you: In a Japanese study, 1155 patients underwent surgery for cervical myelopathy in a county of 2.26 million people. Most patients were in the 6. or 7. decade of life. Spinal canal stenosis was present in 30% of cases. If the nerve roots close to the spine are irritated or damaged, it is called a radiculopathy, also known as root syndrome.
There are various causes of myelopathy
Of course, as a patient, you would like to know what the Causes of myelopathy are. How constriction occurs in the spinal canal (canalis vertebralis) with consequences? What is symptomatic of cervical myelopathy? Here are the answers.
Basically, damage to the spinal cord can be caused by various mechanisms and factors. In the vast majority of cases, however, myelopathy is acquired during life: If the spinal canal becomes too narrowed, significant instability and changes can occur due to such a stenosis. Lead to deficits and numbness in the arms and legs with disturbance of fine motor skills, sensation, gross strength and gait pattern. Incomplete or complete paraplegia may result if the spinal canal remains constricted and is not widened.
How to acquire myelopathy? Narrowing (stenosis) of the spinal cord and consequent damage to the nerve tracts and nerve roots may be caused by acute traumatic experiences such as z. B. Accidents, herniated discs or falls develop. This clinical picture is also caused by tie changes such as inflammations, but also by tumors or cysts. Solve the different causes Different variants of myelopathy from.
There are three forms of myelopathy:
– the compression myelopathy – the vascular myelopathy – the radiation myelopathy
The first one is Compression myelopathy. It can result from tumors, spinal and meningeal metastases, post-traumatic z. B. after a vertebral fracture, after herniated discs, due to spinal stenosis, spondylosis (wear and tear). In addition to compression myelopathy, reduced blood flow also leads to damage of the nerve cells in the spinal cord. Circulatory disturbances occur in the case of vascular malformations or vascular constrictions (stenoses). Acute blood loss can also lead to an undersupply of the spinal cord (shock symptoms). If these causes are present, we speak of a vascular myelopathy. You have probably heard of radiation damage. In fact, damage to the spinal cord can occur during radiation therapy. If this is the case, we speak of a radiation myelopathy.
In myelopathy, symptoms develop gradually
A myelopathy is caused by various Symptoms attention. They depend primarily on the region of spinal cord damage. The symptoms usually develop with a gradual progression. In cases of pure spinal cord compression, which is usually painless, years may pass from the first symptom to diagnosis of. The first signs may be numbness in the hands or soles of the feet, clumsiness of the hands, and unsteadiness when walking in the dark. For all forms of myelopathy, the damaged spinal cord segments can no longer properly perform their function in the nervous system, resulting in neurological deficits.
Some patients complain of pain in the neck radiating to the arms or numbness or even loss of strength in the arms. Important signs of myelopathy are neurological disorders. Symptomatic is also falling asleep of the arms or hands during sleep at night. Initial symptoms may include increasing stiffness in the neck with pain when turning the head left and right. If the myelon, or spinal cord, is damaged, symptoms may also radiate to the legs and cause gait unsteadiness and loss of bladder or bowel control. The spinal cord is a conduit of nerve tie. It transmits information from the brain to the body and vice versa. The myelon lies in the spinal canal. Fine motor disturbances in the hands may increase, writing may become angular and 'spidery', and things may fall out of the hand. It is also more difficult to button shirts and blouses.
Symptoms of cervical myelopathy (cervical spine)
Cervical myelopathy (cervical means "belonging to the neck or neck part of an organ (cervix)") has a progressive course. At the onset of the disease, there are mild motor (gait disturbances) and sensory functional deficits of the upper and/or lower extremities. Unilateral compression in cervical myelopathy can cause sensory disturbances and increasing motor deficits (Brown-Sequard syndrome) in the extremities (the arm is the upper extremity and the leg is the lower extremity).
Symptoms of thoracic myelopathy (BWS)
Myelopathies of the thoracic spine (thoracic myelopathies) have similar typical symptoms to those in the cervical spine. The symptoms appear insidiously and result from the loss of function of the respective affected spinal cord areas. Characteristics are stiffness in the legs, weakness in the leg muscles, breathing difficulties, atrophy of leg muscles, sensory disturbances of the legs and feet, gait disturbances, sensory disturbances, paralysis, bladder and bowel emptying disturbances.
Vascular myelopathies manifest themselves in different functional failures, depending on the affected vessel. Patients complain of weakness, numbness, impaired fine motor skills, bladder emptying, balance and sexual dysfunction, and muscle stiffness. In advanced stages, tie atrophy and respiratory problems may occur.
Myelopathy makes it difficult for the physician to make a diagnosis
Basically, two things need to be said about the diagnosis:
1. An accurate diagnosis is a prerequisite for appropriate therapy.
2. The earlier a diagnosis can be made, the sooner a disease is detected, the better the prognosis for a full recovery. This is plausible, and you may have experienced it yourself. Motto: Quickly recognized – quickly banished!
The Diagnosis of myelopathy on the other hand makes it difficult for the physician. There is a reason for this: there is no specific early diagnosis sign. In other words, the disease process in myelopathy is often characterized by a gradual and unspectacular course with slow deterioration. As a result, a diagnosis is often only made at an advanced stage of the disease. Besides the disease itself, this is the insidious factor in myelopathy.
Therefore, it is especially important to use a two-pronged approach in the diagnostic process. Two-pronged means conversation and clinical examination. So, on the one hand, the doctor will ask you about the type of symptomatology (loss of function, numbness, pain, bladder or rectal dysfunction. Secondly, about known previous diseases: Bekhterev's disease, spondyloarthritis, osteoporosis, herniated disc, arterial circulatory disorders or radiation therapy undergone.
Neurological status with examination of gait, tests for pathological reflexes and sensory disturbances (anesthesia) follows in the diagnostic procedure.
Subsequently, imaging diagnostics, such as MRI (magnetic resonance imaging) are applied. Conventional X-rays can show bony changes well. Additional functional images should always be taken to detect any instability that may be present.
Magnetic resonance imaging is the most important examination method to detect myelopathy. Myelopathy can be clearly seen in the magnetic resonance imaging slice images. MRI often shows the altered tie in the spinal cord (brighter than the adjacent tie). Thus, it is the method of choice for diagnosis. First, it can be used to see structures compressing the spinal cord, such as a herniated disc or tumors. On the other hand, damaged spinal cord regions can be distinguished from healthy nerve tie in MRIs. The electrophysiological measurements (such as nerve conduction velocity, evoked potentials, etc.) are performed.) give important information about the spinal cord function.