Bleeding in the spinal canal
Bleeding in the spinal canal
ANATOMY OF THE SPINE
The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid.
The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus).
The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.
Bleeding in the spinal canal can be either traumatic or non-traumatic (eg, due to vascular malformations, hemorrhagic diathesis). With regard to the compartment in which the bleeding occurs, it can be divided into (1) intramedullary (within the spinal cord), (2) subarachnoid (between the arachnoid membrane and the pia mater), (3) subdural (between the arachnoid membrane ) and dura) and (4) epidural (outside the dura).
CAUSE OF SYMPTOMS
Acute compression of the spinal cord and/or nerve roots
SYMPTOMS AND SIGNS
Total/partial paralysis and numbness from the site of the spinal cord damage downwoads
Pain, numbness and weakness in the limbs
THE DIAGNOSIS IS BASED ON Medical history Clinical exam
and at least one of the following tests: Computer tomography Magnetic resonance imaging (MRI)
A CT image of an acute cervical epidural bleeding
The treatment may be non-surgical or surgical.
WHEN SHOULD AN OPERATION BE PERFORMED?
Neurological symptoms caused by compression of the spinal cord or nerve roots
WHAT IS THE GOAL OF SURGERY?
To release the compressed nerve roots and/or spinal cord
To restore the protective function of the spine
HOW IS SURGERY PERFORMED?
Posterior spinal canal decompression
WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)? Arteriovenous malformation (AVM) Tumor of the spine