The Pathophysiology of Spinal Cord Disorders

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  • 脊髄疾患の病態生理(<特集>脊椎・脊髄の外科治療[1])

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Abstract

In cervical spondylosis, the dynamics of the cervical spine plays an important role in the cord insult. In this regard, it is well recognized that the extension of the cervical spine aggravates narrowing of the spinal canal, thereby resulting in cord compression, a phenomenon termed the pincers mechanism. In patients with this condition, long tract signs such as spasticity in the legs are among the clinically predominant symptoms. In contrast, however, very little attention has been paid to neck flexion, and when the neck is flexed, the spinal cord elongates and compresses against the anterior structure of the spinal canal. Under certain conditions, such elongation and compression can exceed the range of physiological tolerance and results in a cord insult. When this occurs, the intramedullary pressure of the spinal cord increases and ischemic changes are liable to take place, thereby causing a scenavio in which the grey matter can be greatly affected by this impedment. On the other hand, the dynamics of the thoracic spine are limited when compared to the dynamics of the cervical or lumbar spine. However, even though the thoracic dynamics are considered negligible the author presents three cases of a thoracic extramedullary tumor in which the dynamics of the thoracic spine played an important role in aggravating the long tract signs. The author concludes by stating that when treating patients with spinal cord disorders, the pathophysiological factors should be considered, especially the dynamics of the spine and the spinal cord.

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