Spinal Syndromes: Types, Anatomy, Differential Diagnosis and Treatment

General features

The spinal cord is the main way of communication between the brain and the rest of the body. It is a tubular structure, fragile and long that starts from the base of the brain down.

Patients with spinal cord syndromes represent true neurological emergencies.

As with other neurological problems, doctors must first locate and then differentiate the type of damage in order to initiate the most effective interventions.

The differential diagnosis for a marrow syndrome varies from mechanical to vascular, infectious, inflammatory, neoplastic and toxic etiology.

A careful history regarding a remote or recent trauma, other systemic symptoms or toxic habits can help reduce its complications.

The determination of the rate of progression of symptoms is critical, since patients whose symptoms reach maximum involvement in minutes are more likely to have a mechanical or vascular cause instead of an infectious, inflammatory or neoplastic cause.

Anatomy of the spinal cord

To help with localization, remember that the spinal cord segments do not line up with the vertebrae that carry the same names.

The spinal cord ends around L1, with the roots of the horse’s tail below that vertebral level.

In addition, within the cervical cord, the spinal roots leave the spinal canal above the associated vertebral level, with the exception of C8, which exits between C7 and T1. Thereafter, each spinal root comes out below the corresponding vertebral body.

Motor system:

The majority of the corticospinal tract, which mediates a large proportion of our volitional movements of the extremities, is pronounced in the marrow before descending into the contralateral lateral corticospinal tract.

Sensory system:

The afferent sensory fibers of the dorsal root ganglia enter the spinal cord at the dorsal horn. From there, its course depends on the type of modality that is transmitted.

For example, pain and temperature fibers travel rostrally within the Lissauer tract through one or two spinal segments before synapsing into the dorsal horn and crossing into the contralateral anterolateral system.

The anterolateral system is composed of the anterior spinothalamic tract, which carries sensory fibers to the touch, and the lateral spinothalamic tract, which transports the fibers of pain and temperature.

Differential diagnosis for spinal syndromes:

Compressive / mechanical:

  • Trauma
  • Herniated disc
  • Epidural abscess
  • Hematoma epidural
  • Epidural neoplasia / metastasis
  • Vertebral compression fracture

Vascular:

  • Ischemic stroke
  • Dural arteriovenous fistula
  • Arteriovenous malformation
  • Cavernous malformation

Inflammatory:

  • Multiple sclerosis
  • Optic neuromyelitis
  • Mielitis sideways
  • Acute disseminated encephalomyelitis
  • Sarcoidosis
  • Paraneoplásico
  • Systemic lupus erythematosus
  • Antiphospholipid antibody syndrome
  • Sindrome de Sjögren
  • Mixed connective tissue disease
  • Behçet’s disease

Toxic / metabolic:

  • Heroin
  • Arachnoiditis after angiographic / myelographic contrast agents
  • Methotrexate toxicity
  • Cytarabine toxicity
  • Toxicity by amphotericin B

Infectious:

  • Poliovirus
  • Enterovirus
  • West Nile Virus
  • Japanese encephalitis
  • Encephalitis transmitted by ticks
  • Herpes simplex virus
  • Virus varicela-zoster
  • Cytomegalovirus
  • Virus de Epstein-Barr
  • Influenza

Bacterial:

  • Mycoplasma pneumoniae
  • Syphilis
  • Tuberculosis
  • Lyme’s desease

Fungus:

  • Cryptococcus neoformans
  • Coccidioides immitis
  • Blastomycetes dermatitides
  • Histoplasma capsulatum

Parasites:

  • Species of Schistosoma
  • Toxoplasma gondii
  • Taenia solium

Classic syndromes of the spinal cord

Central cord syndrome (syringomyelia):

Cervical spondylosis underlying with hyperextension injury; damage relatively greater to gray than to white matter.

Weakness in upper extremities greater than in lower extremities; You may have bladder dysfunction and varying degrees of sensory loss in or below the injury.

Brown-Sequard syndrome:

Penetrating trauma (many non-penetrating injuries show partial asymmetric syndromes).
Contralateral pain, temperature loss two levels below the injury.

Previous cord syndrome:

Hypotensive event that causes infarction within the middle thoracic region or hyperflexion injury that leads to compression of the anterior spinal artery.

Posterior cord syndrome:

B 12 deficiency, vascular malformations, atlantoaxial subluxation.

Cauda Syndrome:

  • Hernia discal, tumor.
  • Asymmetric weakness of the lower extremity, sensation of irregular alteration in all modalities, loss of deep tendon reflexes, as well as bulbocavernosus reflex and anal wink, often with lumbar and radicular pain.

Conus medullaris syndrome:

Disc herniation, trauma, tumor.

Symmetric sacrum, lumbar weakness (may have normal leg strength), bowel / bladder dysfunction.

Treatment of some types of spinal syndromes by means of cryotherapy

Spinal syndromes, particularly of the cervical and lumbar vertebrae, also represent a relatively large indication group for cryotherapy of the whole body.

They are so common that terms such as “disk damage / discopathies”, “sliding disc / lumbago” or “ischial syndrome” are not unknown to us and are almost considered part of everyday language.

Also grouped under the term “back pain”, they are mainly caused by degenerative modifications of the discs and small vertebral joints.

However, the muscles and tendons that serve as support and support devices for the spine can also participate somatically or functionally in the disease.

A painful muscle hardening arises reflexively through the strong impulses of the nociceptors in the area of ​​the spine.

Inflammatory processes also act as a cause or in parallel to degenerative changes.

The “back pains” have a strong tendency to become chronic and cause physical inactivity, defective demands on the locomotor system and reactive depressive states.

Cold treatment can promote standard therapies very effectively, and you can even replace them sometimes.

The disease that keeps the muscle hardening recedes (reduction of nociceptive impulses).

When cold therapy is introduced on time and combined with therapeutic behavioral measures, the course of the disease can be prevented from becoming chronic. Up to 20 exposures are recommended for a cold application in series.