Spinal Vascular Disease

Introduction to spinal vascular disease Spinal vascular disease is a group of diseases in which spinal cord dysfunction is caused by occlusion or rupture of blood vessels supplying the spinal cord. The blood supply to the cervical spinal cord is from the vertebral artery, and the vertebral arteries on both sides merge into the anterior spinal artery. The thoracic spinal cord anterior artery descends. The thoracic spinal cord is supplied by the intercostal artery. The lower thoracic and lumbar spinal cords are supplied by the descending branches of the aorta and the branches of the internal iliac artery. The anterior spinal artery supplies 2/3 of the ventral side of the spinal cord, and the posterior spinal artery supplies the 1/3 of the dorsal aspect of the spinal cord. The lateral side is supplied by the spinal cord artery. Spinal cord 2 to 4 is the junction of the cervical vertebral artery and the thoracic spinal cord, and the blood supply is poor. basic knowledge The proportion of sickness: 0.01% Susceptible people: more than 45 years old Mode of infection: non-infectious Complications: paraplegia

Causes of spinal vascular disease

Disease factor (36%)

Myocardial infarction, cardiac arrest, aortic rupture, aortic angiography, chest and remember, etc. cause severe hypotension, as well as atherosclerosis, syphilitic arteritis, tumor, arachnoid adhesions, etc. can lead to ischemic spinal cord disease. Spontaneous hemorrhage is more common in spinal arteriovenous malformations, aneurysms, blood diseases, tumors, and anticoagulant therapy. Spinal vascular disease is often a complication of other diseases and is easily masked by the primary disease.

Spinal vascular malformation (23%)

It is a common spinal vascular disease. The deformed blood vessels can compress the spinal cord. The occlusion causes spinal cord ischemia. The rupture causes bleeding and the spinal cord function is impaired. About one third of the patients have diseased spinal cord segmental hemangioma, intracranial vascular malformation and syringomyelia. Symptoms, etc.

Trauma (30%)

Trauma is the main cause of intraspinal hemorrhage.

Pathophysiology

The spinal cord is more resistant to ischemia, and mild intermittent blood supply does not cause significant damage to the spinal cord. Complete ischemia for 15 minutes can cause irreversible damage to the spinal cord. Thrombosis of the anterior spinal artery is common in the neck and thoracic marrow, and the segment is the weak area of blood supply; the left posterior artery of the spinal cord is one of the left and right, and thrombosis is rare. Spinal cord infarction can lead to degeneration and necrosis of nerve cells, softening of gray matter and infiltration of perivascular lymphocytes, late thrombosis, replacement by fibrous tissue, and revascularization. Intramedullary hemorrhage often invades several spinal cord segments, mostly located in the central gray matter; hemorrhage or blood enters the subarachnoid space outside the hemorrhage, tissue edema around the hemorrhage, blood stasis and secondary nerve tissue degeneration. Spinal vascular malformations can occur in any segment of the spinal cord, consisting of dilated tortuous vessels forming a reticular vascular mass and its upper and lower feeding arteries and drainage veins.

Spinal vascular disease prevention

Active treatment of the primary disease. Pay attention to safety in production and life, and try to avoid trauma. Once the disease has to be treated in time, early detection, early diagnosis and early treatment are the key to prevention.

Spinal vascular disease complications Complications

The spinal cord is small in size and compact in structure. Once a lesion occurs, obvious symptoms will appear. The upper cervical lesion sometimes affects breathing and is life-threatening, and the disease is prone to paraplegia.

Symptoms of spinal vascular disease Common symptoms Lower extremity weakness Spinal cord compression Spinal cord infarction sphincter dysfunction Paraplegia vascular malformation Defecation disorder Intermittent claudication Sensory disorder Back pain

Vascular malformations can cause symptoms due to segmental arterial thrombosis, bleeding or compression of the spinal cord, and can be slowly progressive spinal cord compression to produce sensory and secondary disturbances.

1. Ischemic disease

(1) Transient ischemic attack of the spinal cord: Intermittent claudication of sudden onset is a typical manifestation of this disease. It lasts for several minutes to several hours and can be completely recovered without leaving any sequelae. It can also show spontaneous paroxysmal weakness of the lower extremity. Repeated attacks can be relieved by themselves, rest or use of vasodilators can be relieved, and intermittent symptoms disappear.

(2) Spinal cord infarction: a stroke-like onset, which often peaks in minutes or hours.

1 anterior spinal artery syndrome: the anterior spinal artery supplies 2/3 of the front of the spinal cord, prone to ischemic lesions, more common in the middle thoracic or lower thoracic segment, the first developmental symptoms often occur at the corresponding site of root pain or Diffuse pain, rapid sputum sputum in a short period of time, converted to spastic sputum after the spinal shock period; conduction beam type separation dysfunction, painful sensation loss and deep sensation retention (post-suspension is not involved), urinary dysfunction obvious.

2 posterior spinal artery syndrome: the posterior spinal artery is rarely occluded, because of good collateral circulation, even if the symptoms are milder and recover faster; acute root pain, deep sensory loss and sensory ataxia below the lesion level, Pain and muscle strength are preserved, and sphincter function is often unaffected.

3 Central artery syndrome: rapid neuronal spasm in the corresponding segment of the lesion level, muscle tension reduced, muscle atrophy, multi-only pyramidal damage and sensory disturbance.

2, hemorrhagic diseases: including epidural, subdural and intraspinal hemorrhage, sudden acute back pain, paraplegia, lesions below the level of sensory loss and sphincter dysfunction and other complex spinal cord transverse damage, subdural hematoma The epidural hematoma is rare, and the subarachnoid hemorrhage in the spinal cord is rapid, showing neck and back pain, meningeal irritation and paraplegia. The blood vessels on the surface of the spinal cord may have only back pain and no spinal cord compression.

3, vascular malformations: the vast majority of arteriovenous malformations, more common in the thoracolumbar segment, followed by the middle thoracic segment, the cervical segment is rare; arterial and venous rare, arteriovenous malformations are divided into four types: fine meningeal artery spasm Intramedullary arteriovenous malformation, young arteriovenous malformation and periarthrular arteriovenous fistula, etc., mostly before the age of 45, about half of them before the age of 14 years, the ratio of male to female is 3:1, more common on slow onset, Can also be intermittent disease course, symptomatic phase; sudden onset is caused by rupture of abnormal blood vessels, mostly with acute pain as the first symptom, manifesting meningeal irritation, different degrees of paraplegia, root or conduction beam dysfunction, such as spinal cord half Involved in the manifestation of spinal cord syndrome, sphincter dysfunction early in the urinary dysfunction, advanced incontinence; a small number of patients showed a simple spinal subarachnoid hemorrhage.

Spinal vascular disease examination

1, cerebrospinal fluid examination: spinal cord arachnoid hemorrhage CSF bloody; CSF protein increased in spinal canal obstruction, low pressure.

2, lumbar puncture: spinal cord infarction can appear spinal cord swelling, but the lumbar puncture of the spinal canal is mostly smooth, cerebrospinal fluid protein can be slightly elevated. Intraspinal hemorrhage can lead to increased pressure in the cerebrospinal fluid. The formation of hematoma can cause different degrees of obstruction in the spinal canal, which increases the protein in the cerebrospinal fluid and reduces the pressure. The subarachnoid hemorrhage is homogeneous in the cerebrospinal fluid.

3, CT or MRI: can show local thickening of the spinal cord, hemorrhage, infarction, and can be found in deformed blood vessels.

4, myelography: can determine the location of the hematoma, showing the location and extent of spinal deformity vessels, but can not distinguish the type of lesions, selective spinal angiography is the most valuable for the diagnosis of spinal vascular malformations, can clearly show the size, extent, type of deformed blood vessels The relationship with the spinal cord contributes to the choice of treatment.

Diagnosis and diagnosis of spinal vascular disease

diagnosis

According to the sudden onset, accompanied by pain, exercise, sensory and autonomic dysfunction, the manifestations of spinal cord injury and symptoms and signs are consistent with the distribution of spinal cord blood vessels, combined with cerebrospinal fluid and spinal imaging can make a clinical diagnosis. However, there are many diseases that cause transection or partial damage of the spinal cord, which increases the difficulty of diagnosis and differential diagnosis.

Differential diagnosis

Need to be identified with the following diseases:

1, intermittent claudication: (1) vascular intermittent claudication, lower extremity atherosclerotic stenosis, lower extremity arterial vasculitis or repeated embolization of microemboli and other causes, intermittent pain, weakness, pale, lower extremities Reduced skin temperature, weakened or disappeared dorsal artery pulsation, and ultrasound Doppler examination is helpful for diagnosis. (2) The intermittent claudication of the horsetail is caused by the narrowing of the lumbar spinal canal. Often there is pain in the lumbosacral region, the symptoms are aggravated after walking, and the symptoms are relieved or disappeared after the rest. The symptoms of the lumbar flexion can be alleviated, the weight is increased when the back is raised, and the symptoms are heavier than the symptoms of the exercise.

2, spinal epidural arteriovenous fistula: refers to the supply of spinal cord or nerve roots of the small arteries in the intervertebral foramen through the dura mater and the spinal cord drainage veins appear mutual traffic, leading to venous hypertension. Most manifested as progressive aggravation of spinal cord ischemic lesions. More common in middle-aged men, the average age of onset is about 50 years old, often progressive onset, gradually appearing lower limb weakness, sensory disturbance, often accompanied by urinary dysfunction. Usually develops into paraplegia in 2-3 years.

3, acute myelitis: manifested as acute onset of transverse spinal cord injury, but the history of infection or vaccination history, the onset is not as fast as vascular disease, no acute pain or root pain and other first symptoms, the number of cerebrospinal fluid cells can be Significantly increased, hormone therapy has a certain effect, mild patients have self-limiting, the prognosis is relatively good.

4, subacute necrotizing myelitis: may be a spinal cord thrombophlebitis, more common in adult males, manifested as slow progressive progressive lower limb weakness with muscle atrophy, hyperreflexia, pathological signs positive, damage below the plane feeling Obstacles, urinary dysfunction. The lumbosacral segment is the most susceptible, and the thoracic segment is rare.

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