Spinal cord compression pathophysiology: Difference between revisions

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*The cord floats in the cerebrospinal fluid which acts as a buffer to movement and early degrees of compression.  
*The cord floats in the cerebrospinal fluid which acts as a buffer to movement and early degrees of compression.  
*The cord substance contains a gray area centrally and is surrounded by white matter communication tracts, both ascending and descending.
*The cord substance contains a gray area centrally and is surrounded by white matter communication tracts, both ascending and descending.
===Pathogenesis===
*The spinal cord and nerve roots depend on a constant blood supply to perform axonal signaling.
*Conditions that interfere, either directly or indirectly, with the blood supply will cause malfunction of the transmission pathway.
*Injury to the spinal cord or nerve roots arises from stretching or from pressure.
*It initiates a cascade of events in the gray matter and white matter, and results in hypoperfusion and eventually hemorrhagic necrosis.
*The extent of necrosis depends on the severity of the trauma, concomitant compression, perfusion pressures and blood flow, and administration of pharmacological agents.
*The tissue responses by gliosis, demyelination, and axonal loss.
*This results in injury to the white matter (myelinated tracts) and the gray matter (cell bodies) in the cord with loss of sensory reflexes (pinprick, joint position sense, vibration, hot/cold, pressure) and motor function.
*Rapid compression will result in the collapse of the venous system, resulting in vasogenic edema.
*Vasogenic edema exacerbates parenchymal pressure and may lead to rapid progression of dysfunction.


== References ==
== References ==

Revision as of 13:37, 13 April 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Pathophysiology

Anotomy

  • The spinal cord extends from the foramen magnum down to the level of the first and second lumbar vertebrae.[1][2]
  • At L2 level spinal cord transforms into spinal roots and forms a cone-shaped structure called conus medullaris.
  • The cord is protected by the vertebral column, which is mobile and allows for movement of the spine.
  • It is enclosed by the dura mater and the vessels supplying it.
  • The cord floats in the cerebrospinal fluid which acts as a buffer to movement and early degrees of compression.
  • The cord substance contains a gray area centrally and is surrounded by white matter communication tracts, both ascending and descending.

Pathogenesis

  • The spinal cord and nerve roots depend on a constant blood supply to perform axonal signaling.
  • Conditions that interfere, either directly or indirectly, with the blood supply will cause malfunction of the transmission pathway.
  • Injury to the spinal cord or nerve roots arises from stretching or from pressure.
  • It initiates a cascade of events in the gray matter and white matter, and results in hypoperfusion and eventually hemorrhagic necrosis.
  • The extent of necrosis depends on the severity of the trauma, concomitant compression, perfusion pressures and blood flow, and administration of pharmacological agents.
  • The tissue responses by gliosis, demyelination, and axonal loss.
  • This results in injury to the white matter (myelinated tracts) and the gray matter (cell bodies) in the cord with loss of sensory reflexes (pinprick, joint position sense, vibration, hot/cold, pressure) and motor function.
  • Rapid compression will result in the collapse of the venous system, resulting in vasogenic edema.
  • Vasogenic edema exacerbates parenchymal pressure and may lead to rapid progression of dysfunction.

References

  1. Bican O, Minagar A, Pruitt AA (2013). "The spinal cord: a review of functional neuroanatomy". Neurol Clin. 31 (1): 1–18. doi:10.1016/j.ncl.2012.09.009. PMID 23186894.
  2. Diaz E, Morales H (2016). "Spinal Cord Anatomy and Clinical Syndromes". Semin. Ultrasound CT MR. 37 (5): 360–71. doi:10.1053/j.sult.2016.05.002. PMID 27616310.

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