Acute Spinal Cord Compression.
نویسندگان
چکیده
Copyright © 2017 Massachusetts Medical Society. Acute compression of the spinal cord is a devastating but treatable disorder. Diseases that cause acute spinal cord compression constitute a special category because they originate in the spinal column and narrow the spinal canal. This review addresses the disorders that account for most instances of acute spinal cord compression: trauma, tumor, epidural abscess, and epidural hematoma. The pathophysiological features and management of these disorders are similar to those of other acute and serious spinal conditions. The medical context of spinal cord compression determines the diagnosis and directs treatment. Traumatic cord compression is often self-evident. Cord compression in patients with cancer is generally due to metastasis to the spinal column, cord compression in patients with sepsis or in patients who are intravenous drug users suggests epidural abscess, and cord compression associated with anticoagulant therapy, antiplatelet therapy, or coagulopathy is likely to be caused by epidural hematoma. The disorders discussed here also damage vertebrae, intervertebral disks, ligaments, and facet joints, leading to instability of the spinal column. Stability is defined by the retention of normal spinal alignment under physiologic conditions (loads) such as standing, walking, bending, or lifting. This biomechanical concept is essential to an understanding of cord compression, because spinal instability (see the Glossary) permits subluxation of vertebrae (spondylolisthesis), which narrows the spinal canal. Instability that poses a risk of cord damage generally requires surgical fixation of the spine, and bony fusion of adjacent vertebrae (spinal fusion) may be necessary for durable stabilization.
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ورودعنوان ژورنال:
- The New England journal of medicine
دوره 376 14 شماره
صفحات -
تاریخ انتشار 2017