RESUMO
Cervical spondylotic myelopathy is the most severe consequence of degenerative disease of cervical spine. In this article we perform a bibliographic review, addressing current controversies in its pathophysiology. Present work lines of most groups dedicated to the study of this condition are focused on improving surgical techniques designed for the treatment of this disease. Pathophysiological studies are scarce, and most of our pathophysiological knowledge of cervical spondylotic myelopathy is based in works done in 60s and 70s. Literature of the last decade lacks neurochemichal studies parallel to those existing for acute spinal injury. In the same way, only three prospective clinical trials comparing conservative and surgical treatment have been done, and none of them has demonstrated clear superiority of surgery. Given the high prevalence of this disease, the need for deep knowledge of its pathophysiologic, neurochemichal and molecular basis, and the optimization of surgical treatment is justified. This probably implies the need for prospective randomized trials to determine which patients are going to benefit from surgery.
Assuntos
Vértebras Cervicais , Doenças da Medula Espinal/fisiopatologia , Osteofitose Vertebral/fisiopatologia , Humanos , Doenças da Medula Espinal/etiologia , Osteofitose Vertebral/complicaçõesRESUMO
Spinal extradural angiolipomas are rare benign tumours, accounting for only 0.14-1.2% of all spinal neoplasms. They are usually localized within the thoracic extradural space of the spinal canal and their common clinical presentation is myelopathy, mainly in the way of a slowly progressive paraparesis and sometimes in an acute form. We report the case of a 85 year old man who complained of bilateral lower limb weakness with sphincter disturbance of acute instauration. The MRI showed a posterior extradural lesion at L1-L2 level that compressed conus medularis and cauda equina. He underwent urgent surgical treatment and we achieved total resection of the lesion via a L1-L2 laminectomy. The pathological examination confirmed the tumour as an angiolipoma.
Assuntos
Angiolipoma/patologia , Neoplasias da Medula Espinal/patologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Angiolipoma/complicações , Angiolipoma/cirurgia , Diagnóstico Diferencial , Progressão da Doença , Eletromiografia , Humanos , Laminectomia/métodos , Extremidade Inferior/fisiopatologia , Região Lombossacral/patologia , Região Lombossacral/cirurgia , Imageamento por Ressonância Magnética , Masculino , Paraparesia/etiologia , Paraparesia/fisiopatologia , Índice de Gravidade de Doença , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/etiologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/cirurgiaRESUMO
Los angiolipomas espinales extradurales son tumores de carácter benigno poco frecuentes, que representan el 0,14-1,2 por ciento de todas las neoplasias raquídeas y se localizan preferentemente a nivel torácico. Clínicamente suelen presentarse como mielopatía, que puede debutar de forma aguda o instaurarse crónicamente. Presentamos el caso de un varón de 85 años con clínica de inicio agudo consistente en paraparesia espástica, acompañada de alteración de esfínteres. En la RM dorso-lumbar se objetivó una neoformación intrarraquídea a nivel L1-L2, que ocupaba el espacio epidural posterior, comprimiendo el cono medular y la cauda equina. El paciente fue intervenido con carácter urgente, realizándose una laminectomía L1-L2 y consiguiéndose la exéresis total de la neoformación. El estudio anatomopatológico fue informado como angiolipoma (AU)
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