The role of altered cerebrospinal fluid dynamics in pathogenesis of multilevel myelopathy with single spinal stenosis

摘要

Spinal myelopathy is the most serious condition of spondylosis and is the most commonly acquired cause of spinal cord dysfunction among those aged around the fifth decade . The symptoms and signs with which myelopathy pa-tients present are dependent on the relative degree to which the posterior, dorsolateral and ventrolateral columns, the ventral horns, and the nerve root of the spinal cord are involved . In most cases, patients present with more than one of the aforementioned structures being affected.The/major factor causing the myelopathy in spinal Stenosis has been thought to be the arterial insufficiency due to the mechanical compression imposed by the stenosis within the spinal canal j The commonly accepted pathogenesis is that localpschemia of the cord produced by mechanical compression of the cord causes myelopathy, and that ithis ischemia is magnified and made irreversible by a disturbance in the blood supply from the systemic circulation . Consequently, the myelopathy occurred just aroun'd stenotic level. Whereas, for cases of single spinal stenosis with multilevel myelopathy, magnetic resonance (MR) images and computed tomography (CT) of the spine usually show intramedullary abnormalities of signal intensity involving -subtotal spinal cord on T2-weighted images and isolated stenosis at the pathological level . Thus, it is far-fetched to be explained with the vascular hypothesis for imageology characteristics of this type of myelopathy (see Fig. 1)