health of the nervous system

A.Griguolo myelopathy

Generality

Myelopathy is the medical term for any spinal cord disease or suffering.

In light of this, myelopathies are: spinal stenosis (which recognizes numerous causes), myelitis (also presenting a wide spectrum of possible causes), spinal cord injuries resulting from spinal trauma and vascular diseases of the spinal cord.

A myelopathy induces different symptoms, depending on what caused it (ie the causal factor) and on the affected spinal cord tract.

Myelopathies require treatment based on the causes and severity of the symptoms; such a therapeutic approach, however, is possible only after a scrupulous diagnostic investigation, which also brings to light the precise causes of spinal cord suffering.

Brief review of the Spinal Cord

The spinal cord is, together with the brain, one of the two fundamental components of the central nervous system .

Structurally very complex, this vital nervous organ has several groups of neurons (arranged in white and gray matter ) and 31 pairs of nerves (the so-called spinal nerves ), and covers the important task of sorting incoming and outgoing signals between the different brain areas ( lobes of the brain, cerebellum, etc.) and the rest of the organism.

The spinal cord takes place, in order to receive protection, inside the so-called spinal canal, ie the conduit resulting from the overlapping of vertebral vertebral column and their characteristic holes.

What is a myelopathy?

Myelopathy is the term that in the medical field indicates any disease or suffering of the spinal cord.

Under the heading "myelopathy", therefore, belong conditions such as: spinal stenosis (or spinal stenosis ), myelitis (that is inflammation of the spinal cord), spinal cord injuries of traumatic origin ( myelic lesions or spinal injuries ) and spinal cord vascular disease ( vascular myelopathy ).

Based on this list, the picture related to myelopathies appears quite simple; in reality, this is only true in appearance: conditions such as spinal stenosis and myelitis, for example, are both related to a wide range of causes, which greatly complicate every discussion related to myelopathies.

Meaning of the word Myelopathy

The term "myelopathy" is the result of the union of the word "honey", which refers to the spinal cord, and of the word "patia", which in medicine means disease.

To remember

The word "myelopathy" should not be confused with the word " myopathy "; the latter, in fact, indicates any disease or suffering of the muscles and their functionality.

Causes

This chapter devoted to the causes of myelopathies will discuss, firstly, the causative factors of spinal stenosis, myelitis, traumatic spinal cord injuries and spinal cord vascular diseases, and, later, of the ways in which doctors classify a generic myelopathy.

Spinal stenosis

Spinal stenosis is the medical expression indicating any pathological narrowing of the spinal canal, which causes a more or less severe compression of the spinal cord.

The phenomenon of spinal stenosis, with all its consequences, represents the most widespread myelopathy.

The causes of spinal stenosis include:

  • Osteoarthritis of the spine . Also known as spondylosis, this condition is the result of a gradual degeneration of the vertebral column, due to the precision of the bodies of the vertebrae (or vertebral bodies).

    Favored by factors such as advanced age, obesity and poor posture, spondylosis is the main cause of spinal stenosis.

  • Spinal tumors . They are clusters of abnormal cells located on the spine.

    Spinal tumors cause spinal stenosis, because, with their mass (which is constantly expanding), they deprive the spinal cord of the space reserved for it, causing its compression.

  • Rheumatoid arthritis . It is a degenerative joint disease that, when it affects the spine, has effects similar to spondylosis.

    According to the reliable opinion of the doctors, rheumatoid arthritis would be an autoimmune disease.

  • The herniated disc . In medicine, the term "herniated disc" indicates the exit of the nucleus pulposus from its natural site (the intervertebral disc), in the direction of the adjacent nerve structures (adjacent tract of spinal cord, spinal roots and spinal nerves) or in the direction of the bodies vertebral neighbors.

    The herniated disc is the cause of myelopathy, when the nucleus pulposus invades, with its spillage, the space reserved for the spinal cord located in the immediate vicinity.

  • Congenital malformations of the spine . Some individuals are born with a narrower spinal canal than normal. The presence of a narrowing of the spinal canal since the birth is an example of congenital spinal stenosis.

Myelitis

Myelitis is the medical condition that results from the inflammation of the gray matter or white matter of the spinal cord.

Myelitis recognizes numerous causes; in fact, it may depend on viral infections (eg: poliomyelitis, AIDS, varicella virus, herpes zoster and West Nile virus), bacterial infections (eg tuberculosis, syphilis, meningitis and Lyme disease), fungal infections (eg: Cryptococcus neoformans, Coccidioides immitis, Blastomyces dermatitidis and Histoplasma capsulatum ), parasitic infections (eg: Schistosoma, Taenia solium and Trichinella spiralis ), autoimmune diseases (eg: neuromyelitis optica, Sjogren's syndrome, multiple sclerosis and systemic lupus erythematosus) and even some vaccines (ex: hepatitis B, measles, mumps and rubella vaccination, and diphtheria and tetanus vaccine).

The inflammation induced by myelitis alters the functioning of the spinal cord ; this is due to the damage that the aforesaid inflammation produces to the neurons of the gray substance and the white substance of the spinal cord tract concerned.

Spinal cord injury of traumatic origin

Spinal cord injuries of traumatic origin are the consequence of severe trauma to the spinal column, which subject the latter to abnormal movements (eg: hyperflexion, hyperextension, rotation and lateral slippage) or which undermine its integrity (cause fracture of a vertebral body, whose resulting fragments damage the spinal cord).

Among the most frequent causes of such traumas to the vertebral column, there are: motorcycle and car accidents, accidental falls on the back (eg: falls from a horse), acts of physical violence and more (eg: gunshot wounds ) and back injuries due to the practice of contact sports (eg: rugby, American football, etc.).

Vascular myelopathy

With vascular myelopathy, doctors intend a more or less serious spinal cord suffering, due to an alteration of the supply of oxygenated blood to the latter (oxygenated blood is essential for the survival of any tissue and organ of the human body, marrow spinal including).

Among the medical conditions that can induce vascular myelopathy, include: atherosclerosis (with its occlusive phenomena), angiopathy induced by diabetes, hematomyelia (is hemorrhage inside the spinal cord), aortic dissection, polyarteritis nodosa (consisting of an inflammation of arterial vessels with lesion effects), the aforementioned systemic lupus erythematosus, neurosyphilis and medullary ischemic phenomena (eg: medullary TIA).

When it is severe, vascular myelopathy can affect the blood supply to the spinal cord so deeply that it causes the death of the latter due to necrosis; necrosis of the spinal cord due to a vascular myelopathy is an example of infarction, ie the process of death of an organ or tissue resulting from the lack of oxygenated blood supply.

Classification of myelopathies

There are two completely different systems for classifying myelopathies: the classification system that distinguishes myelopathies in acute and chronic, and the classification system that distinguishes myelopathies in cervical ( cervical myelopathy ), thoracic ( thoracic myelopathy ) and lumbar ( lumbar myelopathy ).

ACUTE / CHRONIC CLASSIFICATION

The classification of myelopathies in acute and chronic employs, as a distinctive parameter, the speed with which a certain spinal cord suffering establishes its own symptomatology. In detail, all myelopathies with rapid and sudden onset are acute, while all gradual and progressive appearance myelopathies are chronic.

Examples of acute myelopathies are:

  • Spinal injuries of traumatic origin;
  • Vascular myelopathy related to haemorrhagic phenomena (hematomyelia);
  • Transverse myelitis (it is a particular form of myelitis),
  • Spinal stenosis correlated with the presence of a spinal tumor.

Examples instead of chronic myelopathies are:

  • Spinal stenosis due to the presence of spondylosis (arthrosis of the spine), rheumatoid arthritis or herniated disc;
  • Myelitis related to multiple sclerosis;
  • Myelitis due to syphilis.

CLASSIFICATION IN CERVICAL-THORACIC-LUMBAR

The classification of myelopathies in cervical, thoracic and lumbar uses, as a parameter of distinction, the spinal cord tract victim of suffering. From this it follows that:

  • All myelopathies affecting the cervical spinal cord are cervical. The cervical spinal cord is the upper section of the latter;
  • All thoracic spinal cord myelopathies are thoracic. The thoracic tract of the spinal cord is the intermediate section of the latter, beginning immediately after the cervical tract;
  • Finally, all myelopathies affecting the lumbar spinal cord are lumbar. The lumbar spinal cord is the lower section of the latter, immediately following the thoracic section.

Symptoms and Complications

The symptoms and signs of a myelopathy vary, mainly, based on two factors, which are: the triggering cause and the spinal cord that is the subject of suffering.

Without going into the details of the characteristic symptomatology of every possible myelopathy, in a generic list of the symptoms and signs typically observed in the presence of a spinal cord disease, they fall by right:

  • Pain in the neck, back and / or extremities (ie limbs);
  • Sharp pains in the chest and / or abdomen;
  • Sense of stiffness in the neck, back and / or extremities;
  • Urinary disorders (eg urinary incontinence and difficulty urinating, etc.) and intestinal disorders (eg faecal incontinence and constipation);
  • Influenza symptoms such as fever, headache, nausea, vomiting, widespread fatigue, loss of appetite, etc .;
  • Muscle spasms and muscle fasciculations;
  • Loss of reflexes;
  • Paralysis of the upper and / or lower limbs;
  • Sense of muscle weakness in the upper and lower limbs;
  • Loss of skin sensitivity, soreness, tingling and / or burning sensation in the hands and / or feet (paresthesia);
  • Sense of numbness in the face;
  • Posture instability and difficulty walking;
  • Muscular atrophy;
  • Cyst formation filled with fluid in the spinal cord (syringomyelia).

Complications

In the absence of adequate care or if particularly serious, myelopathies are conditions that can give rise to complications; among these complications, the following are worth mentioning: the chronic nature of pain, the increasingly frequent recurrence of muscle spasms, total paralysis of the upper and / or lower limbs, total loss of control of urinary and fecal function, the appearance of sexual dysfunctions ( erectile dysfunction, for men, and anorgasmia, for women), the state of depression that can result from experiencing the previous complications and, finally, the onset of serious and potentially lethal cardiovascular problems .

Diagnosis

Among the investigations and examinations useful for the diagnosis of a myelopathy and the causes of the latter, there are: the patient's account of the symptoms, the anamnesis, the physical examination, an accurate neurological examination, radiological examinations such as the myelography, nuclear magnetic resonance in the spine and CT in the spine, blood tests and lumbar puncture .

In addition to providing a wealth of information on the present condition, such a thorough diagnostic procedure allows, in uncertain cases, to exclude pathologies with similar symptoms step by step, but not associated with spinal cord suffering ( differential diagnosis ).

Why is it important to identify the causes of myelopathy?

The knowledge of the causes of a myelopathy is very important, because it is from the causal factors that the most adequate therapy planning depends.

Therapy

The treatment of a myelopathy varies depending on the cause and in relation to the severity of the symptoms .

Unfortunately, some myelopathies are capable of producing irreversible spinal cord injuries, which even a proper and scrupulous therapy is able to cancel.

Examples of Therapy

  • If myelopathy is a spinal stenosis resulting from a tumor of the spine (spinal tumor), the therapy will consist of a surgical intervention aimed at removing the tumor mass;
  • If the myelopathy is a spinal stenosis due to spondylosis, the treatment will consist, for the less severe cases, in a conservative treatment (anti-inflammatory, physiotherapy, correction of possible postural errors and adoption of a healthy lifestyle) and, for the most cases severe, in a surgical treatment aimed at relieving spinal cord compression (spinal decompressive surgery).
  • If the myelopathy is an autoimmune mold myelitis, the treatment will include the administration of corticosteroids and immunosuppressants, in order to alleviate the present inflammation and mitigate the improper response of the immune system (which is the causal factor of the aforementioned inflammation);
  • If myelopathy is a viral myelitis (ie a myelitis due to a virus), the treatment will include the administration of anti-inflammatories (eg: cortisone drugs) and antiviral drugs (ie medicines with a specific action against viruses);
  • If the myelopathy is a spinal lesion of traumatic origin, the therapy will include immobilization, intravenous administration of a corticosteroid with a high anti-inflammatory action, whose name is methylprednisolone, and a surgical operation on the vertebral column aimed at eliminating any anomalies occurred following the trauma (eg: in the presence of a vertebral fracture, the surgery is used to remove any bone fragments from the fractured vertebra).

Prognosis

Myelopathies are conditions whose prognosis varies according to the severity of the triggering cause: due to a myelopathy due to a clinically relevant causal factor, the chances of a recovery of bone marrow functions are decidedly inferior to the possibilities foreseen for a myelopathy related to a causal factor of mild clinical entity.