Myelopathic syndrome

Myelopathic syndrome includes a symptom complex caused by damage to the membranes, substance, and roots of the spinal cord due to various pathological conditions.

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Causes myelopathic syndrome

Myelopathic syndrome with segmental disorders occurs when the gray matter, posterior (sensory) and anterior (motor) roots are damaged. Damage to the segmental apparatus is accompanied by motor (paralysis and paresis), reflex, sensory, vascular, secretory and trophic disorders.

Myelopathic syndrome with damage to the posterior funiculi at the level of the cervical spine (tumor, injury) is manifested by Lhermitte's symptom; when the head is tilted forward and down, the whole body is pierced by a sharp pain, similar to an electric shock. When the posterior roots are damaged, shooting, encircling pains with irradiation at the level of the affected segment, fibrillatory and fascicular twitching occur, then a decrease or loss of all types of sensitivity develops, paresis or flaccid paralysis with atony and muscle atrophy develops. Reflexes, the arc of which passes through the affected root, may weaken or be lost.

When the posterior horn is damaged, pain usually does not occur, sensitivity disorders are dissociated (pain and temperature sensitivity is lost, but tactile and muscle-joint sensitivity is preserved), reflexes are reduced or disappear. Similar disorders, but bilateral, also occur when the anterior gray commissure is damaged.

Myelopathic syndrome with segmental damage to the lateral horn is characterized by the development of autonomic reflexes with impaired regulation of the function of blood vessels, glands, internal organs, especially those with smooth muscles; trophic disorders with the formation of extensive bedsores (Bastian's law), sweating disorders; reflex functions of the pelvic organs (Brown-Sequard symptom).

Myelopathic syndrome with conduction disorders occurs when the conduction pathways are affected. They are more widespread. All muscles innervated from the underlying segments are paralyzed, anesthesia is formed downwards from the level of the lesion, muscle-joint, tactile, vibration sensitivity is disordered, and sensory ataxia (gait disorder) develops.

The examination complex is very broad and is possible only in a neurosurgical hospital with the involvement of a neurologist, neuro-oculist, neurophysiologist, and, if indicated, an otoneurologist.

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Pathogenesis

The spinal cord has a close anatomical and functional connection with the brain, peripheral and autonomic nervous system, the spine, on the other hand, the function of the spinal cord is affected by metabolic, immunopathological and other processes occurring in the body. Therefore, myelopathic syndrome does not have a single classification. Lesions of the spinal cord cause disorders of the functions of its segmental and conductive apparatus.

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Diagnostics myelopathic syndrome

Topical diagnostics is complex and is the competence of neurosurgeons and neuropathologists (in some cases, sexologists). A general surgeon only needs to identify the myelopathic syndrome and refer the patient to specialists for further examination.

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