Illnesses of a spinal cord often lead to irreversible neurologic infringements and to proof and expressed invalidization. Insignificant on the sizes the pathological centers cause occurrence of pamplegia, paraplegia and infringements of sensitivity from top to bottom from the center as through the small area of cross-section section of a spinal cord pass practically all axifugal impellent and eisodic sensitive spending ways. Many illnesses, especially accompanied a compression of a spinal cord from the outside, carry inversive character in this connection sharp defeats of a spinal cord should be carried to the most critical urgent conditions in neurology.
The spinal cord has a segmentary structure and innervate finitenesses and a trunk. 31 pairs spinal nerves that does anatomic diagnostics concerning simple depart from it. To define localization of pathological process in a spinal cord allow border of frustration of sensitivity, paraplegia and other typical syndromes. Therefore at diseases of a spinal cord careful inspection of the patient with application of additional laboratory tests, including a nuclear magnetic resonance, computer tomography, myelography and research somatosensory the caused potentials is required. Owing to ease in carrying out and the best resolution computer tomography and the nuclear magnetic resonance supersede standard myelography. Especially valuable information on internal structure of a spinal cord gives a nuclear magnetic resonance.
Parity of an anatomic structure of a spine column and spinal cord with clinical symptoms
The universal organization of a longitudinal axis spinal cord by a somatic principle allows to identify easily reasonably the syndromes caused by defeat of a spinal cord and spinal nerves. Longitudinal localization of the pathological center establish on the uppermost border of sensitive and impellent dysfunction. In the mean time the parity between bodies of spondyles (or their superficial reference points, awned shoots) and the segments of a spinal cord located under them complicates anatomic interpretation of symptoms of diseases of a spinal cord. Syndromes of defeat of a spinal cord describe according to the involved segment, instead of a being next to spondyle.
During embryonal progresses the spinal cord grows more slowly a spine column so the spinal cord comes to an end behind of a body of the first lumbar spondyle, and its radices accept more steep descending direction to reach innervate them structures of finitenesses or internal bodies. The useful rule consists in that. That is radices (except for CVIII) leave rachial the channel through apertures above bodies of spondyles appropriating them, whereas chest and lumbar radix — under the same spondyles. The top cervical segments lay behind of bodies of spondyles with same numbers, bottom cervical — on one segment above a spondyle appropriating them, top chest — on two segments above, and bottom chest — on three. Lumbar and sacral segments of a spinal cord [(the last shape a brain cone (conusmedullaris)] are localized behind of spondyles ThIX—li. To specify propagation various extramedullary processes, especially at spondylosis, important carefully to measuresagittal diameters of the rachial channel. In norm at cervical and chest levels these parameters make 16—22 mm; at a level of spondyles li-liii-nearby 15—23 mm and below — 16—27 mm.
Clinical syndromes of diseases of a spinal cord
As the basic clinical symptoms of defeat of a spinal cord serve loss of sensitivity the border which are passing on a horizontal circle on a trunk, i.e. «A level of frustration of sensitivity», and weakness in finitenesses, innervate descending corticospinal fibres. Infringements of sensitivity, especially paresthesia, can appear in stops (or one stop) and to extend upwards, originally making impression about polyneuropathy before the constant border of frustration of sensitivity will be established. The pathological centers leading a break corticospinal and bulbospinal of ways at same level of a spinal cord, cause paraplegia or pamplegia, accompanied increase of a muscular tone and deep tendinous reflexes, and also the symptom of Babynskiy.
At detailed survey usually find out segmentary infringements, for example a strip of changes of sensitivity top level conducting touch frustration (a hyperalgesia or a hyperpathia), and also a hypotonia, an atrophy and the isolated loss deep tendinous reflexes. A level conducting frustration of sensitivity and segmentary semiology approximately specify localization cross-section affect. As an exact localizing attribute the pain felt on an average line of a back, especially at a chest level serves, the pain in interscapular areas can appear the first symptom of a compression of a spinal cord. Radicular pains points on primary localization of the spinal defeat located more lateralis. At involving the bottom department of a spinal cord — a brain cone of a pain are often marked in the bottom part of a back.
At an early stage of sharp cross-section defeat in finitenesses the hypotonia, instead of spasticity because of a so-called spinal shock can be marked. The given condition can be kept about several weeks, and it is erroneous it sometimes accept for extensive segmentary defeat, but later reflexes become high. At the sharp cross-section defeats especially caused by a heart attack, to a paralysis often precede short clonic or myoclonic movements in finitenesses. Other important symptom of cross-section defeat of the spinal cord, requiring close attention, especially at a combination with spasticity and availability of a level of sensitive frustration, vegetative dysfunction, first of all a delay serves wet.
Significant efforts are undertaken for clinical differentiation intramedullary (inside of a spinal cord) and extramedullary compression defeats, but the majority of rules are approximate and do not allow to differentiate one from others reliably. To the attributes testifying in favour of extramedullary of pathological processes, concern radicular pains; a syndrome half spinal affcets Brown-Sekar; symptoms of defeat peripheral effector neuron within the limits of one-two segments, often asymmetric; early attributes of involving of corticospinal ways; essential decrease in sensitivity in sacral segments.
On the other hand, hardly focalized the burning pains, the dissociated loss of painful sensitivity safety of sarcous-articulate sensitivity, conservation of sensitivity in the field of perineum, sacral the segments, late arising and less expressed the pyramidal semiology, normal or slightly changed structure SMZH are usually characteristic for intramedullary defeats. «Untact sacral segments» means safety of perception of painful and temperature irritations in sacral dermatome, it is usual with SIIInoSV. With rostral zones above a level of frustration of sensitivity. As a rule, it is an authentic sign the intramedullary defeats, accompanied involving of the most internal fibres spinothalamic ways, but not mentioning the most external fibres providing touch innervation sacral dermatome.
Browm-Sekar syndrome designate aggregate of symptoms half cross-section defeat of the spinal cord, shown homolateral monocles hemiplegia with loss of muscular-articulate and vibrating (deep) sensitivity a combination with contralateral loss of painful and temperature (superficial) sensitivity. The top border of frustration of painful and temperature sensitivity quite often define on 1—2 segments below a site of damage of a spinal cord as spinothalamic ways after formation synapse in a back horn pass fibres in opposite lateral funicle, rising upwards. If there are segmentary infringements in the form of radicular pains, muscular atrophies, fading tendinous reflexes they usually happen unilateral.
The pathological centers limited by the central part of a spinal cord or mentioning in basic it, mainly amaze neurocyte of grey substance and segmentary conductors, decussate at the given level. The most widespread processes such are a bruise at a spinal trauma, myelosyringosis, tumours and vascular defeats in pool of a forward spinal artery. At involving a cervical department of a spinal cord the syndrome of the central spinal defeat is accompanied by weakness of the hand significantly more expressed in comparison with weakness of a leg, and the dissociated frustration of sensitivity (analgesia, i.e loss of painful sensitivity distribution in the form of a cape on shoulders and the bottom part of a neck, without anesthesia, i.e. losses of tactile sensations, and at safety of vibrating sensitivity).
The defeats localized in the field of body C or below, squeeze the spinal nerves which are a part of a horse tail, and cause languid asymmetric paraparesis with areflexia to which dysfunction of a bladder and an intestines, as a rule, accompanies. Distribution of sensitive frustration reminds outlines of a saddle, reaches level L and corresponds to zones innervation radicular, entering in a horse tail. Achilles and knee reflexes are lowered or are absent. Pains, irradiate in perineum or a hip are often marked. At pathological processes in the field of a cone of a spinal cord of a pain are expressed more poorly, than at defeats a horse tail, and frustration of functions of an intestines and a bladder arise earlier; die away only Achilles reflexes. Compression processes can simultaneously grasp as a horse tail, and a cone and to cause the combined syndrome of defeat peripheral effector neuron with some hyperreflection and symptom of Babinskiy.
The classical syndrome of the big occipital aperture is characterized by weakness of muscles of a humeral belt and a hand after which there is a weakness homolateral legs and, finally, contralateral hands. Volumetric processes of the given localization sometimes give a suboccipital pain extending on a neck and shoulders. Other certificate of a high cervical level of defeat syndrome of Gorner which is not observed at availability of variations below segment ?II serves. Some illnesses can cause sudden «insult-like» myelopathy without previous symptoms. To their number concern a epidural haemorrhage, hemorrhachis, a heart attack of a spinal cord, an incomplete dislocation of spondyles.
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