Senile spinal cord compression

　　The causes of spinal cord compression are roughly divided into four categories, including vertebral compression deformation or destruction of the vertebral arch root, intraspinal tumors, spinal cord tumors, and spinal cord infarction. The most common tumors causing spinal cord compression are breast cancer, lung cancer, lymphoma, and so on.

　　If the lesion progresses and damages the pyramidal tract and extrapyramidal tract, lower limb spastic paralysis will gradually appear, accompanied by positive pyramidal tract signs in both lower limbs. After the ipsilateral cervical cord is damaged, the descending sympathetic fibers are destroyed, and the ipsilateral Horner syndrome may occur. Common autonomic disorders include skin nutritional disorders such as hyperkeratosis, decreased hair, and vascular relaxation disorders, etc. In the later stage of the disease, the empty cavity often involves the nucleus of the trigeminal nerve tract nucleus, resulting in facial onion skin-like loss of pain and temperature sensation, developing from the lateral side to the nasolabial area; involving the nucleus ambiguus causes difficulty in swallowing and coughing when drinking water; involving the hypoglossal nerve causes muscle bundle tremors; involving the facial nerve nucleus causes peripheral facial paralysis; the vestibular cerebellar pathway is involved, resulting in dizziness, nystagmus, and gait instability.

　　In spinal cord compression, 8% to 47% are the initial symptoms of cancer. Before the diagnosis of lung cancer, upper limb, lower limb, or lumbar pain and paresis can occur in 5.3%, of which 1.5% appear as the initial symptom. Since more than 90% of patients first appear pain localized to the involved vertebral body or radiating to the corresponding spinal nerve distribution area, it is often exacerbated by the activity of the lumbar and thoracic back force point affecting the lesion. If not treated, most patients' pain can last for several days, weeks, or even months, followed by weakness of the limbs, descending sensory impairment, and numbness. However, the autonomous dysfunction of defecation and urination often appears late. It should be especially emphasized that once sensory, motor, or autonomic neurological symptoms or signs appear, the condition can rapidly progress. If not treated effectively and promptly, paralysis can occur within a few hours or days. Many clinical experiences show that once paralysis occurs, the possibility of treatment and recovery is significantly reduced.

　　This disease often occurs secondary to other space-occupying diseases, such as spinal cord tumor compression, local abscess formation, and severe lumbar disc herniation leading to this disease. Therefore, early detection, early diagnosis, and early treatment are of great significance for senile spinal cord compression. Once there are suspicious imaging findings of spinal cord compression (CT, MRI), it should be diagnosed in time to reduce the occurrence of this disease.

　　The cerebrospinal fluid and cytological examination of patients with this disease are positive, and more than 2/3 are accompanied by corresponding spinal or trigger points. X-ray film abnormalities can be manifested as disc erosion or loss, partial or complete vertebral collapse, and paravertebral soft tissue masses. Whether the vertebral X-ray film is normal or not, it cannot be肯定 whether there is epidural metastasis.

　　Iodine oil spinal canal selective myelography was widely used, but due to the potential residual stimulation of the subarachnoid space, it needs to be re-evaluated. Now, 36% meglumine iohexol, which is non-irritating, water-soluble, absorbable, and isotonic with cerebrospinal fluid, is used instead of iodine oil. When injecting contrast agent into the lumbar puncture, a 22-gauge or finer needle should be used, and less than 2ml of cerebrospinal fluid should be collected for protein and sugar quantification, and a special filter should be used for cytological examination to increase the positive rate of tumor cells. If cervical puncture is not performed, although it can be replaced by CT examination, the image is often not clear. If there is a condition for performing thin-section CT examination, the image can be clearer. Due to the risk of neurological complications in 14% of patients with complete spinal canal obstruction, recent years have often used non-contrast MRI, which is conducive to the diagnosis of intradural-extramedullary or intramedullary-extramedullary lesions.

　　Patients with elderly spinal cord compression should pay attention to light diet, eat more vegetables and fruits, rationally match their diet, pay attention to sufficient nutrition, and at the same time, avoid eating spicy and stimulating foods, and avoid the intake of greasy foods. If necessary, follow the doctor's advice on diet.

　　The treatment goal of spinal cord compression is to relieve pain, restore or retain neurological function, control local metastatic tumor foci, and maintain vertebral stability. Due to the influence of systemic cancer, a complete cure is unrealistic for at least the vast majority of patients, so it is mainly palliative treatment, and its efficacy is closely related to the pre-treatment neurological condition.

　　1. Corticosteroid Treatment

　　Once the diagnosis of spinal cord compression is established, dexamethasone should be used immediately, which can quickly relieve pain and improve neurological function, and at the same time, cimetidine (cimetidine) or ranitidine should be added to prevent stress ulcers. After the symptoms improve after radiotherapy or surgery, the dosage can be gradually reduced to discontinuation of corticosteroids to avoid serious complications of corticosteroids.

　　2. Radiotherapy

　　In 1966, Mones et al. first reported that 34% of patients with spinal cord compression caused by epidural metastasis from radiotherapy regained the ability to walk. However, the efficacy of radiotherapy for tumors sensitive to radiotherapy such as lymphoma, Ewing's sarcoma, and neuroblastoma is better, followed by metastatic breast cancer, and the efficacy of metastatic lung cancer is poor.

　　3. Surgical Treatment

　　Surgical treatment for spinal cord compression caused by metastatic tumors is an important means of comprehensive treatment. China has carried out more laminectomy, although the efficacy is relatively satisfactory, but should not be satisfied; vertebral resection is more complex and risky, but due to its definite efficacy, it still needs to be considered carefully whether to carry out.