Munyon Charles N, Hart David J
*Department of Neurological Surgery, Temple University School of Medicine, Philadelphia, PA †Department of Neurological Surgery, University Hospitals Neurological Institute/Case Western Reserve University School of Medicine, Cleveland, OH.
Neurologist. 2015 May;19(5):121-7. doi: 10.1097/NRL.0000000000000018.
Vascular insults to the spinal cord are substantially less common than their corresponding events in the brain; it has been estimated, for example, that spinal cord infarcts make up ≤ 1% of ischemic events in the central nervous system. Although the public health burden of spinal cord injury remains severe, the majority of this burden stems from traumatic rather than vascular events. Still, vascular injuries in the spine are common enough and their consequences devastating enough that a familiarity with the pathophysiology, diagnosis, and treatment of the more common etiologies is essential to any practitioner of the clinical neurosciences. In this educational review, we will briefly outline the normal development and anatomy of the spinal vasculature, then focus on specific mechanisms of vascular injury to the spine. In particular, we will examine spontaneous and iatrogenic ischemic insults and their associated clinical syndromes, and then review vascular neoplasms and malformations of the spine with attention to the various management strategies that currently exist for these complex lesions. Finally, we will briefly address the future areas for exploration, including investigative avenues for neuroprotection, as well as the possible influence of atherosclerotic disease on spinal degenerative disease and low back pain.
脊髓血管损伤远比其在脑部的相应情况少见；例如，据估计脊髓梗死在中枢神经系统缺血性事件中所占比例≤1%。尽管脊髓损伤的公共卫生负担依然沉重，但大部分负担源于创伤性事件而非血管性事件。然而，脊柱血管损伤相当常见，其后果也极具破坏性，因此，任何临床神经科学从业者都必须熟悉较常见病因的病理生理学、诊断及治疗方法。在这篇教育综述中，我们将简要概述脊髓血管系统的正常发育及解剖结构，然后重点关注脊柱血管损伤的具体机制。特别是，我们将研究自发性和医源性缺血性损伤及其相关临床综合征，接着回顾脊柱血管肿瘤和畸形，并关注目前针对这些复杂病变的各种管理策略。最后，我们将简要探讨未来的探索领域，包括神经保护的研究途径，以及动脉粥样硬化疾病对脊柱退行性疾病和腰背痛可能产生的影响。
