Syndromes of spinal cord lesions at different levels. Neurological symptoms related to the anatomical structure of the spinal cord and spine. Brain stem: etiological factors of damage
Damage to the spinal cord can manifest as paralysis, sensory disturbances, and pelvic disorders.
The clinical features of these syndromes are as follows:
1) absence of damage to the cranial nerves;
2) a combination of segmental and radicular disorders with conduction disorders caused by the involvement of motor or sensory conduction tracts;
3) the presence of a level of damage - a segmental boundary, above which there are no symptoms, and below which motor, sensory and autonomic disorders are detected.
The level of involvement can often be determined by testing pain or temperature sensation. To determine the affected segment of the spinal cord, the identified level of sensitivity impairment must be raised by another 1-2 segments (for unilateral damage). Since the segments of the spinal cord are displaced upward relative to the vertebrae of the same name, to find out at which vertebral level the affected segment is located, it is necessary to take into account that the spinal cord ends at the level of the L1 vertebra, the sacral segments are located at the level of the Th12-L1 vertebrae, the lumbar segments - at the level of Th10-Th12 , lower thoracic - 2-3 vertebrae higher, upper thoracic - 2 vertebrae higher, lower cervical - one vertebra higher. Therefore, having discovered, for example, a violation of pain sensitivity from the level of the navel (Th10), it is necessary to exclude compression of the spinal cord at the level of the Th7-Th8 vertebrae. The level of damage often helps to establish local pain in the spine.
Damage to the pyramidal tracts running from the motor zone of the cerebral cortex to the anterior horns of the spinal cord causes, depending on the level of the lesion, tetraparesis (with lesions at the cervical level) or lower paraparesis (at the thoracic level), which is accompanied by an increase in tone like spasticity, revitalization of the tendon reflexes, pathological foot signs. With the acute development of severe damage to the spinal cord due to spinal shock, a decrease in tone and suppression of tendon reflexes may be observed, but after a few days, sometimes weeks, the tone begins to increase, brisk tendon reflexes and pathological foot signs appear.
Spinal cord lesion syndromes are divided into syndromes based on length and diameter.
Cause: compression or interruption of the spinal cord as a result of injury, tumor process, inflammation or ischemia.
1. Epidural compression: metastatic tumor (the most common sources are malignant neoplasms of the lungs and breast); in some cases, compression of the spinal cord may be the first manifestation of cancer. Spinal injury. Lymphoma. Multiple myeloma. Epidural abscess or hematoma. Protrusion of the intervertebral disc in the cervical or thoracic region, spondylosis or spondylolisthesis. Subluxation of the atlantoaxial joint (rheumatoid arthritis).
2. Intramedullary space-occupying process: glioma, ependymoma, arteriovenous malformation.
Other intramedullary process: transverse myelitis, vascular myelopathy
Spinal cord lesion syndromes along the length
Establishing the focus of the spinal cord lesion along the length involves identifying topical syndromes along the vertical spinal cord.
The following vertical spinal syndromes are distinguished: craniospinal syndrome, upper cervical (CI-CIV) segments syndrome, cervical (CV-ThII segments) thickening syndrome, thoracic syndrome (ThII - ThXII - segments), lumbar thickening syndrome (LI - SII - segments ), epiconus syndrome (SI - SII - segments), conus syndrome (SIII - SV - segments), epiconus and conus syndrome, cauda equina syndrome.
1) Craniospinal syndrome
is caused by damage to the spinal cord (most often by tumors or injuries) in the area of the transition of the medulla oblongata into the spinal cord or inside the foramen magnum.
- pain or paresthesia in the back of the head and neck, sometimes - pain in the spine and limbs;
- tetraparesis or (plegia) - mixed in nature in the arms and spastic - in the legs, sometimes presented asymmetrically (with a predominance of hemi- or paraplegic options);
- conduction sensitivity disorders, below the CI segment, sometimes asymmetrically expressed (hemi-variant);
- transient breathing disorders due to irritation of the respiratory center of the medulla oblongata;
- various variants of damage to the caudal group (IX-XII) of cranial nerves;
- Horner's syndrome (damage to the sympathetic pathway coming from CII). Miosis due to dilator paralysis, ptosis as a result of damage to the muscle that dilates the palpebral fissure, enophthalmos due to paresis of smooth muscle fibers of retrobulbar tissue.;
- symptoms of intracranial hypertension, including congestive optic discs;
- possible central dysfunctions of the pelvic organs of a conduction nature (urinary and defecation retention).
2) Syndrome of the upper cervical segments CI - CIV:
- spastic tetraplegia;
- radicular (CI – CIV) symptoms;
- with damage to the posterior horns of CI-CIII, dissociated anesthesia occurs in the posterior parts of the face - in the outer zones of Zelder;
- dysfunction of the pelvic organs of the central type;
- diaphragmatic paralysis, hiccups.
3) Cervical thickening syndrome CV-ThII:
- upper flaccid paraplegia;
- disturbance of all types of sensitivity below the level of the lesion according to the conductive type;
- Horner's syndrome: ptosis, miosis, enophthalmos.
4) Thoracic level syndrome ThII – ThXII:
- lower spastic paraplegia;
- disturbance of all types of sensitivity below the level of the lesion according to the conductive type;
- central type urination disorder;
- loss of abdominal reflexes;
- disorder of segmental autonomic reflexes.
5) Lumbar enlargement syndrome LI - SII:
- lower flaccid paraplegia;
- disturbance of sensitivity in the lower extremities according to the segmental type and in the perineum according to the conductive type;
- disturbance of urination of the central type.
6) Epiconus syndrome LIV – SII:
- symmetrical peripheral paresis of the feet with absence of Achilles reflexes;
- dissociated sensitivity disorders along the posterior outer surface of the thigh, lower leg and outer edge of the foot, in the LIV-SV dermatomes;
- erectile dysfunction, sometimes dysfunction of the pelvic organs of a conduction nature (retention of urine and feces).
7) Cone syndrome SSH – SV, CoI:
- dissociated disturbance of sensitivity in the perineal area in the form of a “saddle” of a segmental type;
- lack of anal reflex, impotence and anejaculation;
- disturbance of urination of a peripheral type (paradoxical ischuria).
8) Conus and epiconus syndrome SI – SV:
- paresis or paralysis in the distal parts of the legs (usually the feet) with the appearance of pathological foot reflexes;
- disturbances of sensitivity in the perineum, toes, inner thighs and legs (like cavalry leis);
- retention of urination and defecation;
- disturbance of trophism in the area of the buttocks and feet.
9) Cauda equina syndrome, LII – SV - roots:
- lower flaccid paraparesis, asymmetrical, especially the feet;
- dysfunction of the pelvic organs of the peripheral type;
- pain of a radicular nature, more in a horizontal position, at night;
- impaired sensitivity in the lower extremities and in the perineum, hypo- or anesthesia, often asymmetrical (in the area of LII - SV roots).
Syndrome of dysfunction of the pelvic organs of the central type
The syndrome of dysfunction of the pelvic organs of the central type - urination, defecation and erection - consists of an imperative urge to urinate, urinary retention, periodic urinary incontinence, fecal retention and priapism (involuntary erection), arising from bilateral disruption of cortical connections with spinal centers located in upper lumbar and sacral (S1-SIV) segments of the spinal cord. This occurs with bilateral damage to the spinal cord at the level of the cervical and thoracic segments.
Clinically, this syndrome manifests itself as an initial symptom with an imperative urge to urinate. Subsequently, the patient ceases to feel the urge to urinate and defecate, loses the ability to voluntarily control urination and defecation, does not feel the passage of urine and the catheter through the urethra and the passage of feces through the rectum.
In case of acute dysfunction of urination, urinary retention first occurs. Subsequently, due to the presence of increased reflex excitability of the segmental apparatus of the spinal cord, urinary retention is replaced by periodic incontinence.
In addition to the above-mentioned urination disorders with this syndrome, there is no urge to defecate. Due to the increased tone characteristic of any central paralysis, a spastic state of the rectal sphincters occurs and fecal retention occurs. Sometimes a reflex emptying of the rectum may occur, without the participation of the patient’s will. In addition to the central disturbances of urination and defecation in the syndrome under consideration, for the same reasons - interruption of the cortico-pelvic tract - a pathological erection - priapism - can also occur.
Peripheral pelvic organ dysfunction syndrome
Syndrome of dysfunction of the pelvic organs of the peripheral type - urination, defecation, erection and ejaculation - occurs with disturbances of the segmental and peripheral autonomic innervation of the bladder, rectum and penis as a result of damage to the upper lateral horns of the lumbar segments and sacral (SI-SIV) segments of the spinal column. brain, as well as their roots and n. pelvicus, n.hypogastricus and n.pudendus.
Clinically, this syndrome is manifested by true urinary incontinence, true fecal incontinence - encopresis, inability to erection and ejaculation.
In addition, with the syndrome of a peripheral type of dysfunction of the pelvic organs, another variant of urinary disorders is possible - paradoxical urinary incontinence, which combines elements of urinary retention (the bladder is constantly full and voluntary emptying is impossible) and incontinence (urine constantly flows out of the bladder drop by drop due to for mechanical overstretching of the sphincter).
Syndromes of spinal cord lesions across the diameter
1) Syndrome of damage to the spinal nodes:
Pain (girdling, tightening, shooting),
Disorders of all types of sensitivity, decrease or disappearance of reflexes,
Soreness of paravertebral points. The appearance of herpes zoster in the area of innervation of the affected nodes is especially characteristic.
2) Dorsal root syndrome:
Pain (shooting, girdling, tightening),
Disorders of all types of sensitivity (increase, decrease, loss),
Decreased or loss of reflexes in the area of the affected roots,
Soreness of paravertebral points,
Muscle tension
Limitation of spinal movement in the affected area.
Increased pain when coughing, straining and bending the head.
3) Posterior funiculus syndrome:
Reduction or loss of joint-muscular sensation, vibration sensitivity and partially tactile sensitivity on the affected side downward from the level of the lesion; - sensitive ataxia,
Positive Romberg sign.
4) Syndrome of damage to the lateral cords:
Below the level of the lesion, spastic paresis or paralysis occurs (on the same side) and disorders of pain and temperature sensitivity (on the opposite).
With bilateral damage to the lateral cords, in addition to bilateral disorders of movement and sensitivity, the activity of the pelvic
organs of the central type (retention, periodic urinary incontinence).
5) Dorsal horn syndrome:
Reduction or loss of pain and temperature sensitivity while maintaining joint-muscular sensation and vibration sensitivity (dissociated type of disorder),
Decreased or loss of reflexes in the area of the affected horns.
6) Gray matter syndrome. It is characterized by a break in all pathways crossing in the anterior parts of the gray matter in front of the central canal. As a result, bilateral disorders of surface sensitivity occur. In addition, vegetotrophic disorders, symmetrical peripheral paresis of the upper and spastic paresis of the lower extremities are possible. Occurs in syringomyelia, hematomyelia, and intramedullary tumor.
7) Syndrome of combined degeneration of the posterior cords and corticospinal tracts. There is a violation of deep sensitivity below the lesion, sensory ataxia, and lower spastic paraparesis. This syndrome occurs in pernicious anemia (funicular myelosis) and other forms of malnutrition.
8) Anterior horn syndrome. Signs of peripheral paralysis develop. In isolation they can be affected by acute poliomyelitis, spinal muscular amyotrophy, as well as amyotrophic lateral sclerosis.
9) Syndrome of combined lesions of the anterior horn and pyramidal tract. Symptoms of dissociated paresis, a combination of flaccid and spastic paralysis, develop. Occurs in amyotrophic lateral sclerosis.
10) Syndrome of the anterior and posterior roots and peripheral nerves. It includes a combination of sensory disorders with flaccid paresis, mainly of the distal limbs. In addition, parasthesia and periodic pain are bothersome. Occurs with neural muscular atrophy.
11) Corticospinal tract syndrome. This syndrome manifests itself as progressive spastic spinal palsy. Spastic paraparesis of the legs and spastic gait gradually develop. Spastic paresis of the hands develops later. It occurs in Strumpel's disease; in addition, lower spastic paraparesis occurs in multiple sclerosis, amyotrophic lateral sclerosis, and spinal tumor.
12) Syndrome of combined lesions of the posterior cord, spinocerebellar tracts and, possibly, pyramidal tracts. This combination occurs in hereditary spinocerebellar atrophies. The clinical picture is dominated by a combination of sensitive and cerebellar ataxia, a violation of deep sensitivity of the conduction type and, later, lower spastic paraparesis.
14) Syndrome of complete transverse lesion of the spinal cord - a combination of segmental disorders with conduction disorders below their level in the form of paralysis of the limbs, loss of all types of sensitivity, dysfunction of the pelvic organs, vegetative-trophic disorders (bedsores that quickly become deep, “hard swelling of all tissues below lesion sites, dry skin - anhidrosis, piloarectoral paralysis). The syndrome is observed with a complete transverse lesion of the spinal cord at one level.
15) Intomedullary syndrome. Intramedullary syndrome is characterized by the appearance as initial symptoms of dissociated sensory disturbances and dysfunctions of the pelvic organs of a conduction or segmental nature (depending on the level of localization of the pathological process), a descending (top to bottom) type of development of motor and sensory conduction symptoms and the relatively rapid appearance of a syndrome of complete damage to everything the diameter of the spinal cord, sometimes passing through the stage of Brown-Séquard syndrome.
16) Extramedullary syndrome is characterized by the appearance of radicular pain and radicular hyperesthesia (according to the localization of the extramedullary pathological focus) as initial symptoms, followed by radicular hypoesthesia and Brown-Séquard syndrome. The syndrome has an ascending (from bottom to top) type of development of conduction (motor and sensory) symptoms due to damage, first of all, to longer conduction systems, located, according to Flotau’s law, in the outer sections of the lateral and posterior columns of the spinal cord, and therefore causing the appearance of the first symptoms from the distal parts of the legs and feet. Pelvic conduction disorders (delays in urination and defecation, the need to “strain”) occur only in the late stage of development of the syndrome.
White commissure lesion. Bilateral disorders of pain and temperature sensitivity with preservation of joint-muscular sensation and vibration sensitivity (dissociated type), decrease or disappearance of reflexes in the affected area.
Damage to the anterior horns. Peripheral muscle paralysis, decreased or lost reflexes and fibrillary twitching in the area of innervation of the affected horns.
Damage to the lateral horns. Vasomotor and trophic disorders at the segmental level, and with damage at the level of CvIII - TI segments - Horner's syndrome.
Damage to half the diameter of the spinal cord (Brown-Séquard syndrome)(Fig. 4). Central paralysis, a disorder of joint-muscular sensation, vibration and partially tactile sensitivity on the affected side downward from the level of the lesion. Disorder of pain, temperature and partially tactile sensitivity on the opposite side below the level of the lesion. In the area of the affected segments on the affected side, segmental sensitivity disorders, peripheral paresis or muscle paralysis develop, and reflexes disappear.
Damage to the anterior roots. Peripheral paralysis and muscle atrophy, decreased or loss of reflexes, fascicular twitching in the muscles in the area of innervation of damaged roots.
1. transverse lesion
Most often, the development of complete transverse spinal cord lesion syndrome is associated with spinal injuries with displacement of the vertebrae, combined with compression or complete rupture of the spinal cord, and infectious processes in the spinal cord (myelitis).
Complete spinal cord transection syndrome is accompanied by interruption of both ascending and descending tracts. Clinical manifestations include loss of sensation and movement in a segmental and conductive manner (below the level of the lesion).
Complete disruption of the integrity of the spinal cord is accompanied by symptoms of spinal shock below the level of damage. As a result, the descending inhibitory influences on the inhibitory interneurons of the spinal cord are lost. It is also assumed that direct excitatory supraspinal influences (mainly corticospinal) on α- and γ-motoneurons are lost. Therefore, inhibitory interneuronal intraspinal systems begin to dominate over excitation processes in the spinal cord. As a result, areflexia, atony and then atrophy are observed in the initial stage of spinal shock. This is due to hyperpolarization of motor neurons, which develops as a result of a deficiency of excitation.
Then comes the next stage, which is characterized by hyperreflexia and muscle hypertonicity (spasticity) due to the restoration of excitability of motor neurons.
2. gray
The spinal cord is characterized by the principle of a metameric structure. The term “spinal cord segment” refers to an area of gray matter of the spinal cord with a pair of incoming and outgoing roots. When the gray matter of the spinal cord is damaged, a segmental type of disorder is diagnosed. Moreover, the lesion must involve two or more segments of the spinal cord. In this case, the intersegmental interaction of interneurons of the gelatinous substance of the spinal cord is disrupted and the compensatory principle of innervation is lost. Segments of the spinal cord on the human body are projected in the form of dermatomes: transversely - on the torso, radially - on the face and gluteal region, on the limbs they have a longitudinal strip type of arrangement.
Anterior horn syndrome
The anterior horns of the spinal cord are formed by the accumulation of peripheral motor neurons.
Selective damage to the anterior horn occurs in neuroviral (poliomyelitis, tick-borne encephalitis, etc.) infections and vascular diseases of the spinal cord.
It is characterized by motor disorders such as flaccid paralysis in the muscles of the corresponding myotome on the affected side, as peripheral motor neurons are affected. The differential sign of anterior horn lesions is fascicular muscle twitching resulting from the appearance of spontaneous action potentials in denervated muscles.
Dorsal horn syndrome
It is characterized by a dissociated (loss of one type of sensitivity while maintaining another) type of sensitivity disorder (mainly temperature and pain) on the affected side according to the segmental type in the area of the corresponding dermatome. Deep reflexes fade away as a result of damage to the afferent part of the reflex arc. This syndrome is most often observed in syringomyelia, a late form of neurosyphilis.
Anterior gray commissure syndrome
A dissociated bilateral loss of protopathic sensitivity occurs according to the segmental type (the “butterfly” symptom).
The lateral horn lesion syndrome is manifested by vegetative vasomotor, trophic disorders: increased moisture of the skin, hyperkeratosis (increased dryness of the skin, brittleness and deformation of nails, changes in skin color (pallor, cyanosis, marbling), decreased skin temperature, chilliness, swelling, hair loss, trophic (non-healing) ulcers, bedsores, osteoporosis, osteolysis, lipodystrophy in the innervation zone.
3. rear pillars
Damage to the posterior columns of the spinal cord. When the posterior columns of the spinal cord are damaged, patients may complain of a feeling of squeezing or tightening in the area of innervation of the affected segment, sometimes of paresthesia (resembling the sensation of passing an electric current) that occurs when
bending the head and instantly spreading down the back, reaching the limbs (Lhermitte's symptom). Below the level of the lesion, vibration sensitivity and joint-muscular sensation are impaired, while other types of sensitivity remain intact.
The spinal cord is phylogenetically the most ancient part of the central nervous system, located in the spinal canal. Its upper border corresponds to the exit of the first pair of spinal nerve roots, and the lower border ends with the conus medullaris at the level of the L I - II vertebrae. Conventionally, the spinal cord is divided into 5 sections: cervical (C I - C YIII); chest (T I - T XII); lumbar (L I - L Y); sacral (S I - S Y); coccygeal (CO I - CO II).
A cross-section of the spinal cord reveals a butterfly-shaped gray matter and surrounding white matter. At the level of segments C YIII - L III, the gray matter forms the lateral horns. In the white matter, paired anterior, lateral and posterior cords are distinguished, separated on each side by the anterior roots of the spinal nerves and the posterior horns of the gray matter.
Gray matter consists of neurons and glial elements. The following nerve cells are distinguished:
- motor neurons ) three types - α-large, α-small and γ- neurons. They are located in the anterior horns, and from their axons the anterior roots and then all the structures of the peripheral nervous system (plexuses, nerves) are formed;
- sensitive located in the posterior horns and are the second neurons of pain and temperature sensitivity;
- cerebellar proprioceptor cells located at the base of the posterior horn;
- autonomic (sympathetic and parasympathetic neurons ) located in the lateral horns and are visceromotor cells;
- association multipolar nerve cells , providing intersegmental and intercordial connections of their own and the opposite side.
Posterior funiculi formed by ascending conductors of deep, tactile and vibration sensitivity. IN lateral cords spinal cord there are descending (pyramidal (lateral corticospinal)), red nucleus-spinal and reticular spinal cord) pathways ending on the cells of the anterior horn of the spinal cord and ascending conductors (spinocerebellar anterior and posterior pathways, ascending fibers of superficial sensitivity (lateral spinal cord) - thalamic tract)). Anterior cords The spinal cord is formed predominantly by descending pathways from the precentral gyrus, subcortical and stem nuclei to the cells of the anterior horns of the spinal cord (anterior uncrossed pyramidal tract, vestibulospinal, olivospinal, anterior reticulospinal, tegmental spinal tract, anterior spinothalamic tract).
Complete spinal cord syndrome characterized by central lower paraplegia or tetraplegia, loss of all types of sensation of the conductive type below the site of the lesion, dysfunction of the pelvic organs of the delay type, and vegetative-trophic disorders.
Upper cervical region (C I -WITH IV )
- paralysis or irritation of the diaphragm (shortness of breath, hiccups);
- spastic paralysis of all four limbs;
- loss of all types of sensitivity according to the conductive type, segmental type of sensitivity disorder in the innervation zone C I - C IV;
- dysfunction of the pelvic organs of the central type.
Thoracic region ( TII — TXII )
- central paresis (paralysis) of the lower extremities;
- loss of all types of sensitivity below the level of the lesion according to the conductive type;
- central dysfunction of the pelvic organs.
anterior horn– 1) peripheral paralysis in the muscles of this segment (decreased strength, A reflection (interruption of the efferent link), A tonia (gamma loop rupture), A muscle trophy) + 2) fascicular twitching;
posterior horn– 1) dissociated sensitivity disorder (loss of the superficial while maintaining the deep) on the affected side in the segment zone (“half-jacket”) + 2) areflexia (interruption of the afferent link);
lateral horn– 1) impaired sweating, pilomotor, vasomotor and trophic disorders in the segment area;
anterior gray commissure– 1) dissociated sensitivity disorder (loss of the superficial while maintaining the deep) on both sides in the segment area (“jacket”);
posterior cords– 1) loss of deep sensitivity (posture, locomotion, vibration) ipsilateral + 2) sensory ataxia ipsilateral;
lateral cords– 1) central paresis ipsilaterally (with bilateral lesions - dysfunction of the pelvic organs according to the central type) + 2) disturbance of temperature and pain sensitivity according to the conduction type contralaterally (2 segments below the upper border of the lesion - precrossing is carried out at the level of 2 segments);
anterior spinal artery (Preobrazhensky)- damage to the anterior 2/3 of the spinal cord;
half lesion SM (Brown-Séquard)– 1)loss of superficial sensation ipsilaterally at the level of the segment, contralaterally - 2-3 segments lower according to the conductor type, 2) loss of deep sensitivity ipsilaterally from the level of the lesion, 3) peripheral paresis ipsilaterally at the segment level, central paresis ipsilaterally below the level of the lesion, 4) trophic disorders ipsilaterally at the segment level.
complete transverse lesion of the SM: 1)loss of superficial sensation from the level of damage, 2) loss of deep sensitivity from the level of damage, 3) peripheral paresis at the segment level, central paresis below the level of damage, 4) autonomic disorders
2. Syndromes of complete transverse lesion cm at different levels (Geda-Riddoha, along the length):
craniospinal:
1) sensitive area: A) on both sides in the caudal zones of Zelder, on the back of the head, arms, body and legs, b) pain and paresthesia in the back of the head;
2) motor sphere: a) central tetraparesis, b) breathing problems(diaphragm);
3) central pelvic disorders;
4) vegetative sphere:Bernard-Horner syndrome(damage to the descending sympathetic pathway from the hypothalamus (body)) - autonomic ptosis (narrowing of the palpebral fissure), miosis, enophthalmos;
5) defeat caudal group of cranial nerves;
6) intracranial hypertension.
upper cervical segments(C2- C4) :
1) sensitive area:anesthesia by conduction type, spinal version on both sides on the back of the head, arms, body and legs;
2) motor sphere: A) tetraparesis(VK-mixed, NK-central), b) breathing problems(diaphragmatic paralysis) or hiccups (C4);
3) central pelvic disorders;
4) vegetative sphere:Bernard-Horner syndrome(damage to the path from the hypothalamus);
cervical thickening(C5- Th1) :
1) sensitive area: on both sides on the arms, body and legs;
2) motor sphere: tetraparesis (VC-peripheral, NC-central);
3) central pelvic disorders;
4) vegetative sphere: A) Bernard-Horner syndrome (damage to the ciliospinal center - lateral horns C8-Th1, bodyIIsympathetic pathway); b) autonomic disorders on VK,
thoracic(Th2- Th12):
1) sensitive area:according to the conductor type, spinal version on both sides of the body and legs;
2) motor sphere:central inferior paraparesis;
3) central pelvic disorders;
4) vegetative sphere: A) autonomic disorders on VC, b) cardialgia (Th5).
lumbar enlargement(L1- S2):
1) sensitive area:according to the conductor type, spinal version on both sides on the legs (paraesthesia) and in the perianal area;
2) motor sphere:peripheral inferior paraparesis;
3) central pelvic disorders;
4) vegetative sphere:autonomic disorders on NK.
epicone(L4- S2) :
1) sensitive area:according to the conductor type, spinal version on both sides in the perianal region and along the back of the thigh, legs;
2) motor sphere:peripheral paresis of the feet(loss of Achilles reflex);
3) central pelvic disorders;
4) vegetative sphere:autonomic disorders on NK.
cone(S3- Co2) :
1) sensitive area:anesthesia in the perianal area on both sides;
2) motor sphere:peripheral paresis perineal muscles;
3) peripheral pelvic disorders(incontinence, paradoxical ischuria);
4) vegetative sphere:autonomic disorders functions of the pelvic organs.
horse tail (rootsL2- S5):
1) sensitive area: a) PAIN SYNDROME IN THE AREA OF THE SADDLE AND LEGS, b) asymmetrical anesthesia in the area of the saddle and legs on both sides;
2) motor sphere:peripheral paresis muscles of the NK and perineum (L2-S5);
3) peripheral pelvic disorders(incontinence).
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