Obraz kliniczny mielopatii szyjnej
Clinical picture of cervical myelopathy
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The cervical myelopathy (CM) belongs to the civilization diseases connected to age. The symptoms of the disease were well known from many years after yet the neuroradiological examinations (CT or NMR) can confirmed the diagnosis of cervical myelopathy. In 1928 year Stookey presented the theory of CM aetiology, since other authors have formed their opinions or modified Stookey’s theory. Now is established that the cervical myelopathy is the effects from following abnormalities: 1) the direct pressure of the bone, osteochondrosis or its calcifications changes to spinal cord; 2) the ischaemic changes to cause by pressure to the spinal cord vessels; 3) repetitive microtraumas connected whit the flexion or extension movements of the neck. It is considered that CM develops when the diameter of canal vertebralis narrows by 30%. The spinal cord gets flattened in the anterior-posterior size. Few anatomopathological investigations have shown that on the level of the lesions were observed gliosis or demyelination of the spinal cord. The lateral columns of the spinal cord are more prone to the pressure than anterior or posterior one. The osteochondrosis as the osteophytes are present in 90% of people over 60 years. The initial symptoms of CM are headache or pain of the neck. Later the pain is radiated to shoulders or brachium, the upper limbs weaken, the patient is feeling paresthesias mostly in palms. After some time the lower limbs were found less efficiency and spastic rigidity. The gait to turn slowly and clumsy. The disturbances with continence of urine was also appeared. The muscles atrophy, mainly hands, have been observed as well as impaired deep sensation or vibration. Is characterized the hyperreflexia in upper and lower limbs. Sometimes is appeared a patellar clonus as well as the Lhermitte’s sign. In the differential diagnosis should be taken under consideration many diseases, but the results of the neuroradiological examination should be a decisive factor. We should remember also that the examination of the cerebrospinal fluid is normal. The CM is disease of the slowly progressive course. The surgical treatment of the disease might give better results in the initial stage of the disease – 30% of patients reported the improvements in their condition. In 2 to 3 years after the surgery the symptoms reoccur and the neurological status of the patients is similar to those who have been treated in the conservative way.
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