Spinal vascular disease

　　Ischemic spinal vascular disease is often caused by segmental artery occlusion, such as intercostal artery or lumbar artery occlusion caused by distal aortic atherosclerosis or dissecting aneurysm. In addition, reduced perfusion pressure caused by myocardial infarction or cardiac arrest is also one of the causes of spinal ischemia. Hemorrhagic spinal vascular disease is classified according to its location into extradural, subdural, subarachnoid, and intramedullary hemorrhage. The causes include trauma, spinal vascular malformation, hemopathy, and secondary hemorrhage from tumors, etc. The most common spinal vascular malformation is the cavernous venous malformation and arteriovenous malformation, which are mostly located at the posterior side of the thoracolumbar spinal cord. It can compress the spinal cord or hemorrhage and cause symptoms.

　　Spinal vascular malformation is a non-limiting disease, once the disease occurs, the symptoms will progress and worsen until irreversible damage occurs. Generally, the progressive worsening of bilateral lower limb or urination, defecation and other functions occurs within 2 years, and paraplegia occurs within 2 to 4 years.

　　Spinal vascular disease includes ischemic diseases, hemorrhagic diseases, and vascular malformations. The specific clinical manifestations are as follows:

　　One, ischemic diseases
　　1, Spinal cord transient ischemic attack: Sudden onset of intermittent claudication is a typical manifestation of this disease, lasting for several minutes to several hours, which can be completely recovered without leaving any sequelae. Other manifestations may include spontaneous attacks of distal weakness in the lower extremities, which may recur and relieve spontaneously, rest or the use of vasodilators can relieve symptoms, and symptoms disappear during the intermission.
　　2, Spinal cord infarction: It presents with stroke-like onset, and the symptoms of the spinal cord often reach a peak within minutes or hours.
　　(1) Anterior spinal artery syndrome: The anterior spinal artery supplies the anterior two-thirds of the spinal cord, and ischemic lesions are prone to occur, most commonly in the middle or lower thoracic segments. The initial symptoms are often sudden onset of radicular pain or diffuse pain at the corresponding level of the lesion, followed by flaccid paralysis within a short time. After the spinal shock period, it turns into spastic paralysis, conduction tract-type dissociative sensory disorders, loss of pain and temperature sensation while deep sensation is preserved (the posterior column is not involved), and urinary and fecal disorders are more obvious.
　　(2) Posterior spinal artery syndrome: The posterior spinal artery is rarely occluded due to good collateral circulation, even if symptoms occur, they are relatively mild and recover quickly. The main manifestations are acute radicular pain, deep sensory loss below the level of the lesion, and sensory ataxia, with preservation of pain, temperature sensation, and muscle strength, and the sphincter function is usually not affected.
　　(3) Central artery syndrome: Rapid neuronopathic paralysis at the corresponding segmental level of the lesion, muscle tone reduction, muscle atrophy, mainly pyramidal tract damage and sensory disorders.

　　Two, hemorrhagic diseases
　　Including epidural hemorrhage, subdural hemorrhage, and intramedullary hemorrhage, all appear suddenly with severe back pain, paraplegia, sensory loss below the level of the lesion, and sphincter dysfunction, showing the symptoms of acute transverse myelitis. Subdural hematoma is much less common than epidural hematoma. Subarachnoid hemorrhage from spinal subarachnoid hemorrhage is acute, with symptoms such as neck and back pain, meningeal irritation signs, and paraplegia. Rupture of surface vessels of the spinal cord may only cause back pain without signs of spinal cord compression.

　　Three, vascular malformations
　　The vast majority are arteriovenous malformations, most common in the thoracic and lumbar segments, followed by the middle thoracic segment, and rare in the cervical segment. Arteriovenous malformations are divided into four types: spinal meningeal artery fistula, intramedullary arteriovenous malformation, juvenile arteriovenous malformation, and perimedullary arteriovenous fistula, etc. Most occur before the age of 45, about half before the age of 14, with a male-to-female ratio of 3:1. The onset is usually slow, and it can also be intermittent with symptomatic episodes; sudden onset is caused by rupture of the malformed vessels, mainly presenting with acute pain as the initial symptom, manifested as meningeal irritation signs, varying degrees of paraplegia, radicular or conduction tract sensory disorders, such as the presentation of spinal hemisection syndrome when the spinal cord is involved on one side. Bladder and bowel dysfunction in the early stage is difficult to urinate and defecate, and in the late stage, incontinence occurs.

　　The etiology of spinal vascular disease is unknown, and there are no effective preventive measures. Pay attention to self-protection in daily life, avoid unhealthy lifestyles, and use antibiotics and prevent allergic reactions reasonably. Especially for people with high sensitivity, it is more important to avoid various sensitizing factors, which may help prevent the occurrence of spinal vascular disease.

　　The diagnosis of spinal cord vascular disease relies not only on clinical manifestations but also on auxiliary examinations, which are indispensable. Common examinations include the following:
　　1. Cerebrospinal Fluid Test Cerebrospinal fluid (CSF) is hemorrhagic in spinal subarachnoid hemorrhage; when there is spinal canal obstruction, CSF protein levels increase and pressure is low.
　　2. CT or MRI It can show local thickening, hemorrhage, and infarction of the spinal cord, and after enhancement, abnormal vessels can be found.
　　3. Spinal Cord Angiography It can determine the location of the hematoma, show the position and extent of the spinal cord vascular malformation, but cannot distinguish the type of lesion. Selective spinal artery angiography is of great value for the diagnosis of spinal cord vascular malformation, which can clearly show the size, extent, type, and relationship of the malformation vessels to the spinal cord, which is helpful for the selection of treatment methods.

　　Patients with spinal cord vascular disease should eat high-protein and nutritious foods; eat foods rich in vitamins and minerals; eat high-calorie and easily digestible foods. Patients should avoid greasy and difficult-to-digest foods; avoid fried, smoked, grilled, cold, and刺激性 foods; avoid high-salt and high-fat foods.

　　The treatment of spinal cord vascular disease depends on the etiology. The treatment principles for ischemic spinal cord vascular disease are similar to those for ischemic cerebrovascular disease. Mannitol and other drugs can reduce spinal cord edema; for hypotensive patients, blood pressure should be corrected; vascular dilators and drugs to promote nerve function recovery should be used. Symptomatic treatment and supportive therapy, strengthening nursing care, and preventing bedsores and urinary tract infections are necessary.
　　During the acute phase of spinal cord hemorrhage, absolute bed rest should be maintained, and analgesic drugs should be administered for pain. For epidural or subdural hematomas, emergency surgery should be performed to remove the hematoma, relieve the pressure on the spinal cord, and the earlier the surgery, the better the effect. Vitamin K should be administered for spinal cord hemorrhage caused by coagulation disorders. After the acute phase, rehabilitation exercise should be performed as soon as possible to promote functional recovery.
　　Abnormal vascular malformations can be removed by microsurgery. Due to the development of vascular intervention science, embolization is simple and easy to perform and can be carried out simultaneously with angiographic diagnosis, making it the first choice method. The abnormal artery for embolization cannot be the blood supply artery of the spinal cord, and it is required to be completely occluded at the orifice and the starting end of the vein to prevent recurrence.