Lower limb weakness

Introduction Lower extremity weakness is caused by cervical spondylotic myelopathy. It is characterized by weakness, numbness, tightness, and heavy feeling of lower limbs. Gradually, there are also phenomena such as lameness, trembling, gait shaking, and easy fall. Cervical spondylotic myelopathy is a type of cervical spondylosis. Cervical spondylosis can be roughly divided into four types: cervical cervical spondylosis, radiculous cervical spondylosis, vertebral artery type cervical spondylosis, and cervical spondylotic myelopathy. Cervical spondylosis, also known as cervical vertebra syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, and cervical disc herniation. It is a disease based on degenerative pathological changes. Mainly due to long-term cervical vertebrae strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical syndromes of dysfunction. The manifestations of cervical disc degeneration and its secondary pathological changes, such as vertebral instability, loosening; nucleus protruding or prolapse; spur formation; ligament hypertrophy and secondary spinal stenosis, etc., stimulated or oppressed Adjacent nerve roots, spinal cord, vertebral artery, and cervical sympathetic nerves, and cause a variety of symptoms and signs of the syndrome.

Cause

The pathogenesis of cervical spondylotic myelopathy mainly includes four aspects: dynamic factors, mechanical factors, vascular factors and congenital development factors:

(1) Dynamic factors. Insular instability, looseness, posterior longitudinal ligament bulging, wrinkles, nucleus pulposus and hypertrophy of the ligamentum flavum protrude into the spinal canal and cause spinal cord compression. These conditions can disappear due to changes in body position.

(2) Mechanical factors. The posterior margin of the vertebral body is hyperplastic, and the nucleus pulposus protrudes or emerges to form adhesions and mechanization, which may cause continuous compression of the spinal cord, or when the cervical vertebra moves, the spinal cord rubs back and forth in the protruding part, and the spinal cord may be compressed or Stimulated to produce symptoms.

(3) vascular factors. The blood supply to the spinal cord is an important basis for maintaining the spinal cord to complete various complex activities. Once some blood vessels are subjected to compression or stimulation, the stenosis and stenosis occur, and the corresponding dominant area is ischemic, causing paralysis.

(4) Congenital development factors. Congenital stenosis of the sagittal diameter of the cervical spine is also a cause that cannot be ignored.

an examination

Related inspection

Neurological examination of X-ray lipiodol

The diagnostic criteria are:

1 Clinically, there is spinal cord compression, which is divided into central type, peripheral type and central vascular type. Symptoms start from the upper limbs and affect the whole body as the central type; the symptoms start from the lower limbs, and the whole body is surrounded by the surrounding type; the upper and lower limbs also have symptoms of the central vascular type, also known as the limbs. Each type is light, medium and heavy 3 degrees;

2X-ray films showed sagittal stenosis of the spinal canal, hyperosteogeny, vertebral instability and trapezoidal changes;

3 except amyotrophic lateral sclerosis, spinal cord tumor, syringomyelia, spinal cord injury, spinal tuberculosis, skull base depression, secondary adhesion arachnoiditis, multiple peripheral neuritis, etc.;

4 for those who have difficulty in differential diagnosis, can be used for lumbar puncture cerebrospinal fluid examination and myelography; 5 can choose CT, magnetic resonance imaging and digital subtraction and other special examination according to the needs of the disease. Although the incidence of cervical spondylotic myelopathy is lower than that of nerve root type and vertebral artery type, accounting for 10%-15% of the total number of various types, but because of its severe symptoms and chronic progressive development, it is harmful to the human body. Once misdiagnosed, it will delay the timing of treatment. Regardless of the doctor or the patient, cervical spondylotic myelopathy should be given high priority. For patients with cervical spondylotic myelopathy, timely and accurate treatment can achieve satisfactory results.

Differential diagnosis

Differential diagnosis of lower limb weakness:

1. Amyotrophic lateral sclerosis: mainly with spastic quadriplegia, no sensory disturbance, and often invades the medulla and causes the lower cranial nerve symptoms.

2, multiple sclerosis: often both brain and spinal cord symptoms, bladder dysfunction occurs before the limb dyskinesia.

3. Central paralysis of the lower extremities: The central paralysis of the lower extremities is a clinical manifestation of congenital hydrocephalus. When the hydrocephalus is severe and the progress is rapid, it may also appear. The symptom is repeated vomiting. Brain degeneration, brain developmental disorders, central limb spasm, especially lower limbs.

4, lower limb swelling and fatigue: lower limb swelling and fatigue is one of the symptoms of deep vein thrombosis.

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