Spinothalamic tract compression

Introduction When the spinal cord is compressed, dyskinesia occurs before the sensory disturbance. In addition to the compression of the spinal cord tissue, it may be accompanied by blood circulation disorders, cerebrospinal fluid dynamics, and complications such as inflammation and adhesion. Therefore, clinical performance presents diversity and complexity.

Cause

The spinal cord and spinal nerve roots in the plane of the primary intraspinal tumor are compressed. For the continuation of the lateral bundle of the spinal thalamus and the anterior bundle of the spinal thalamus, the two are gradually approaching in the brainstem, also known as the ridge system. The fiber bundle is accompanied by a spinal cord network that terminates in the brainstem network, a midbrain bundle that stops at the midbrain cap and the gray matter surrounding the aqueduct. In the medulla, they are located in the lateral zone, on the dorsolateral side of the lower olive nucleus; in the pons and midbrain, on the dorsolateral side of the medial collateral. The spinal thalamus bundle finally reaches the posteromedial nucleus of the thalamus, transmitting the pain and temperature of the contralateral trunk and limbs and the rough touch pressure. From the gray matter layer I and IV~VII of the spinal cord, it is the fiber bundle that rises on the opposite side after the white matter anterior commissure, and transmits the opposite side of the painful temperature and pressure. On one side, there is contralateral pain and temperature disturbance. .

an examination

Related inspection

Spinal MRI

Generally, the development of extra-osseous tumor compression symptoms is divided into three phases:

(1) Early compression: nerve root pain.

(2) Compression progression: spinal cord hemisection syndrome (brown-sequard syndrome).

(3) The spinal cord is fully stressed: the spinal cord is traversed. This classification is still the basis of the current clinical classification.

The positioning of the spinal cord compression plane mainly depends on the following aspects:

1. The spinal cord is affected by root pain or root distribution in the area dominated by the compression site of the tumor.

2. The plane in which the sensory disorder lies should have no difficulty in diagnosing the spinal compression plane during the complete compression of the spinal cord, but it is too late. Many authors have pointed out that radiculopathy is a common first-episode symptom and important for early localization diagnosis. After the nerve root is destroyed by compression, localized segmental sensation is caused. After the spinal thalamus bundle is compressed, because of its layered arrangement in the spinal cord, the early sensory loss plane of the extramedullary tumor does not really indicate the segment where the tumor is located. If nerve root pain and spinal thalamic tract symptoms coexist, and the planes of the two are inconsistent, nerve root pain has a more positive positioning value.

3. The muscles innervated by the tumor compression zone are delayed. In the motor system, tumor compression and stimulation of the anterior horn of the spinal cord or the anterior root of the spinal nerve cause the lower motor neuron, which is more obvious in the neck enlargement area and has a higher positioning value.

4. The reflection associated with the segment where the tumor is located disappears. As the spinal cord and spinal nerve roots in the plane of the tumor are compressed, the reflex arc is interrupted and the reflection is weakened or disappeared. However, below this plane there will be deep reflection enhancement, weak reflection or disappearance, or pathological reflex.

5. Changes in autonomic function. There is no sweat or less sweat below the tumor plane, but its positioning is not as reliable as the sensory plane. And it has little significance for cervical spinal cord tumors.

Differential diagnosis

Differential diagnosis of spinal thalamus bundle compression:

1. Intramedullary tumor: common clinical pathological type is glioma (epenomyema, astrocytoma); nerve root pain is less common; its sensory changes are most obvious in the lesion segment, and develop from top to bottom , segmental distribution, sensory separation; may have lower motor neuron symptoms, muscle atrophy; pyramidal tract signs appear late and not obvious, spinal cord hemisection syndrome is rare or not obvious; spinal canal obstruction appears late or not Obviously, the protein content of cerebrospinal fluid is not obvious, and the symptoms are not obvious after the cerebrospinal fluid is released; the ridge pain is rare, and the bone changes in the spine are rare.

2. Extramedullary tumors: common clinical pathological types are neurofibromatosis, meningioma; radiculopathy is more common, and has the value of localization diagnosis; sensory changes in the distal extremity feel changes significantly, and from the bottom up, no Sensory separation phenomenon; pyramidal beam sign appeared earlier and significant, lower motor neuron symptoms were not obvious, spinal cord hemisection syndrome was more common; spinal canal obstruction appeared earlier or obvious, cerebrospinal fluid protein increased significantly, release cerebrospinal fluid due to myeloid The external tumor moves down and the symptoms worsen; the ridge pain is more common, especially in the epidural tumor, and the bone mineral changes in the spine are more common.

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