Cauda Equina Syndrome ne Acute Spinal Cord Compression Red Flags¶

Cauda Equina Syndrome (CES) ne Acute Spinal Cord Compression (mudi Metastatic Spinal Cord Compression [MSCC] ne Spinal Epidural Abscess) i bilumbu bia tshimpitshimpi bia mu lungenyi mudi tshitupa tshinene tshia mubidi tshidi tshinyanguka, tshimpumpu, tshitupa tshia mashi anyi tshitupa tshia mashi tshidi tshinyanguka mu tshitupa tshia mukolo anyi tshia mu tshiadi ne miji ya mijilu ya sacral ku nshindamenu wa mukolo. Nansha mudi 95 pa lukama ya disama dia mu tshiadi ne dia sciatica wa ku luseke lumue bikale ntatu ya mecanique idi ikola padibu bakisha ne baondapa, 5 pa lukama ya disama dia mukolo didi dilondangana ne bimanyinu bia "Red Flag" bia mu mikolo bidi mua kufikisha ku disama dia kashidi, didi kadiyi mua kupingana dia maulu onso abidi, dijimija dia matuku onso a muoyo wa tshiadi ne dia mala (dipeta dia dikala), anyi dilengeja dia mubidi dia kashidi anyi dia kashidi dijimija dia mudimu wa masandi pikala dipanda dia mubidi dienzeke panyima pa mêba 24 too ne ku 48. Dijingulula dia lukasa dia bimanyinu bia kumpala bu mudi "saddle anesthesia" (dipanga dia lungenyi padibu basukula ne dibeji dia tshiibi), dielakana anyi dilama dia mashi adi kaayi ne kanyinganyinga, anyi disama dia sciatica didi ditangalaka mu maulu onso abidi didi dipetesha babedi mushindu wa kupita kumpala kua liste ya kuindila ya lupitadi ne kuya buludiludi ku tshibambalu tshia lukasa lukasa bua kuenza MRI ne disama dia mukolo dituku dimue dimue adi dipanda.

Enza nunku mpindieu¶

1. Tangila diakamue 4 cardinal Cauda Equina Syndrome Red Flags ("Saddle, Bladder, Bowel, Bilateral Legs"). Shi muntu udi ne disama dia mukolo anyi sciatica udi ne tshimue tshia ku bimanyinu bidi bilonda ebi, udi mua kutshiangata bu tshilumbu tshia lukasa tshia mu nzubu wa lupitadi:
2. Disama dia tshibandilu / Dipanga dia lungenyi: Dipanga dia lungenyi, dipanga dia lungenyi, "bipese ne tusuyi," anyi dijimija dia diumvua dia "novocaine-like" mu miaba idi mua kulenga tshibandilu tshia kabalu (mu matamba, mu tshiadi, mu tshiadi, mu tshifu/tshiamu tshia balume, anyi mu tshiadi/mu tshiadi), misangu ya bungi bitu bimueneka bu disama dishilangane padibu basukula ne dibeji tshiibi.
3. Dipanga dia mudimu wa tshiadi: Dikokangana dia kutuadija dipatuka dia mashi (dielakana), dijinga dia kuenza mudimu ne misunyi ya mu tshifu bua kuela mashi, dipanga dia mashi ditekete anyi dipueka, dijimija dia lungenyi lua pa tshibidilu lua se: tshifu tshidi tshiuwule tente, kubenga kumvua mashi apita mu tshina tshia mashi, anyi **dipanga dia mushindu wa kuela mashi mutantshi wa \(6\**t\**\**to {}\)xt/xt/xt\xt.
4. Dipanga dia mudimu wa mala anyi dia masandi: Dijimija dia tshimpitshimpi dia lungenyi lua se: tshifu tshidi tshiuwule tente, dipanga dia mushindu wa kukanga tshitupa tshia munda tshia tshifu, dinyanguka dia tshifu tshia mpukapuka/dipanga dia kulama, anyi dijimija dia tshimpitshimpi dia lungenyi lua mu bitupa bia lulelu anyi mushindu wa kufika ku dikola anyi ku dijikija lutetuku.
5. Bilateral anyi Progressive Sciatica / Motor Weakness: Disama dia mijilu ya sciatic, dipanga dia lungenyi, anyi butekete budi buenda bupueka ku maulu onso abidi musangu umue (anyi dishintuluka dia dikasa dimue kuya ku dikuabu), anyi dikuluka dia makasa dia tshimpitshimpi (dikuluka bualu minu kayena mua kubandila mulu) anyi dikuluka dia binu.
6. Ndaku buludiludi ku tshibambalu tshinene tshia lupitadi tshidi ne mushindu wa kuenza MRI ne dipanda dia mukolo mu mêba 24 (anyi ubikile 911 / 112 / 999 wewe kuyi mua kuenda). Ela 911 mu États-Unis ne mu Canada, 112 mu Union européenne mujima, 999 mu Royaume-Uni, anyi tangila bionso nomba ya tshimpitshimpi. KUYI kuya ku lupitadi lua lukasa lukasa, ku biro bia luondapu lua kumpala, anyi ku munganga wa mikolo, bualu nzubu ayi kayena ne tshiamu tshia MRI tshia lukasa anyi munganga wa mitu udi muaba au to, ne nebijimije mêba a bungi kumpala kua kukutumabu.
7. Kulama mubedi tshintu nansha tshimue ku mishiku (NPO: kakuyi biakudia, mayi, anyi manga a disama dia mukana) kubangila ku dîba diudi uya ku lupitadi. Bikala tshikebelu tshia MRI tshia lukasa tshijadika ne: udi ne disama dia Cauda Equina anyi disama dia mukolo wa mukolo, munganga wa mifuba anyi munganga wa mifuba neaye ne mubedi buludiludi mu nzubu wa dipanda dia lukasa bua dipanda dia mishiku anyi dipanda dia mishiku anesthésie générale. Kudia biakudia anyi kunua maluvu mu njila wa kuya ku ER kudi mua kuenzeja bua kuenza anesthésie mêba 6 anyi 8.
8. KENJI KUENZA mudimu wa dishintulula dia mukolo, dilongolola dia tshitupa tshia mubidi, dilengeja dia mubidi, dilengeja dia mesa, anyi dilengeja dia mukolo ku bukole. Shi disama dia lumbar disc munene, tumor metastatic, anyi epidural hematoma dikadi difina ku mukolo wa mukolo anyi ku mijilu ya cauda equina, dikosa anyi dishintulula dia mikolo didi mua kukosa mijilu idi mishale idi kayiyi minyanguke ne kufikisha ku paraplegie irrestant.
9. Bua mubedi udi ne disama dia kansere ne disama dia mukolo dipiadipia: Mulale diakamue pa mukolo. Mu Metastatic Spinal Cord Compression (MSCC), tshitupa tshia tumor tshidi tshitekesha mufuba wa mukolo too ne padi mukolo ulua mubi. Kusomba mululame anyi kuimana kudi kuteka bujitu bua tshitupa tshia mubidi tshidi tshikuluka; UK NICE Guideline NG234 udi ulomba bua kulama babedi badibu bela meji ne: badi ne disama dia MSCC balale panshi (supine) too ne padi MRI ujadika ne: mukolo udi mushindame.
10. Ku tshibambalu tshia malu a tshimpitshimpi, amba patoke mêyi aa: "Ndi ne disama dia mukolo ne [disama dia tshibandilu / dishintuluka dia tshifu / diteketa dia maulu abidi] ne ndi dijinga ne dikonkonona dia lukasa bua kumbusha disama dia Cauda Equina." Funda dîba dijalame divua tshimanyinu tshionso tshia dibendele dikunze tshituadije, ne udilongolole bua kupima lukasa mutoyi wa ku luseke lua bulalu (mutoyi wa mu tshifu tshipiminu tshia mashi tshidi tshishala panyima pa dipanga dia tshintu) ne MRI wa Lumbar Spine wa tshimpitshimpi.

Disungula dia dibendele dikunze dia mukolo ne mutshi wa dipangadika dia tshienzedi¶

Ingidija tshikandakanda etshi bua kusunguluja disama dia mukolo dia pa tshibidilu anyi disama dia tshiadi dia ku luseke lumue ne masama anayi a mukolo (Cauda Equina Syndrome, Metastatic Spinal Cord Compression, Spinal Epidural Abscess, and Spinal Epidural Hematoma).

flowchart TD
    Start["Mubedi udi ne disama dia mukolo anyi dia nshingu,<br/>Sciatica, anyi butekete bupiabupia bua dikasa/diboko"] --> TraumaCheck{"Bualu ebu buvua buenzeke kunyima kua disama dia mubidi dikole anyi?"}

    TraumaCheck -->|"EYOWA: Disama dikole"| TraumaGuide["Londa mikenji ya mputa ya mukolo:<br/>Kuteka mutu/nshingu mu mulongo, KUENJI mubedi,<br/>Bikila 911 / 112 / 999 (Tangila mukanda wa mputa ya mukolo)"]

    TraumaCheck -->|"TO: Tshibangidilu tshia patupu, tshia dibandisha, anyi tshia ku kakese ku kakese"| CESCheck{"Tangila Cauda Equina Red Flags (L2 to S4 Nerves):<br/>1. Disama/disama mu tshiadi, mu matama, anyi muaba wa kukupula?<br/>2. Lutatu lua kutuadija tshisuku, tshipepele tshikole, anyi dilama?<br/>3. Dijimija dia diumvua dia mala anyi dia mu tshiadi anyi disama dia mu bitupa bia lulelu anyi?<br/>4. Sciatica anyi butekete mu maulu onso abidi (anyi dikuluka dia makasa didi dienda dikola)?"}

    CESCheck -->|"EYOWA: Tshimanyinu tshionso tshia CES"| GoER_CES["MUSHINDU WA LUPILU LUA KUPATULA (Mudibu bela meji ne: CES):<br/>1. Enda ku lupitadi lua ER ne 24/7 MRI & Spine Surgery NOW<br/>2. Kulama tshintu ku mishiku (NPO) bua dipanda dia lukasa<br/>3. KUENJI, kukosa, anyi kunyanga mutshi wa mukolo<br/>4. Lomba tshikebelu tshia tshifu tshia panyima pa dipanga dia mashi + MRI wa tshimpitshimpi"]

    CESCheck -->|"TO"| CordCheck{"Tangila dikuma dia muonji wa mukolo,<br/>Kansere (MSCC), anyi disama (tshipupu) Bimanyinu bikunze:<br/>1. Kansere mumanyike/wa kale + disama dia mu tshiadi dipiadipia/dia butuku anyi?<br/>2. Kapia, mashika, dikuatshika dia manga mu IV, anyi diela dia mukolo dia matuku mashale aa?<br/>3. Bintu bidi bitekesha mashi + disama dia mukolo dia tshimpitshimpi dia buena dia tshingoma kunyima kua epidural?<br/>4. Dienda dia 'robo' dikole, dienza dia malu ne lukasa, anyi disama dia mu tshiadi?"}

    CordCheck -->|"EYOWA: Kansere, Kapia/Sepsis, Anticoagulant,<br/>anyi Bimanyinu bia Upper Motor Neuron Cord"| GoER_Cord["MUSHINDU WA KUENZA MU MUKOKO WA LUPILU:<br/>1. Enda ku tshibambalu tshia malu a tshimpitshimpi diakamue<br/>2. Shi udi wela meji ne udi ne disama dia kansere (MSCC): Lala panshi pa mukolo (supine)<br/> bua kuepuka dikuluka dia tshitupa tshia mubidi<br/>3. Udi dijinga ne MRI wa mukolo mujima + IV Dexamethasone (bua MSCC)<br/> anyi IV Antibiotics/Surgical Drainage (bua Epidural Abscess)"]

    CordCheck -->|"NO: Sciatica wa ku luseke lumue anyi anu disama dia mukolo dia muaba umue,<br/>mu tshifu/mu mala/tshibandilu tshia pa tshibidilu, bukole bua pa tshibidilu"| RoutineSciatica["Disama dia mukolo didi kadiyi dikole / Sciatica wa ku luseke lumue:<br/>- Mbimpe bua kuondopa ne luondapu lua kumpala ne dienda dia bupole<br/>- Tangila bimpe bimanyinu bia Red Flag 'Safety Net' dituku dionso;<br/> ndaku diakamue ku ER pikala tshimanyinu tshia tshibandilu anyi tshia tshifu tshimueneka"]

Anatomie 101: Bua tshinyi muonji wa mukolo ne Cauda Equina badi benza malu mushindu mushilangane¶

Bua kumvua bua tshinyi dikuma dia nshingu anyi dia munkatshi mua mukolo didi difikisha maulu makole ne a nsongo (Dikuma dia muonji wa mukolo / Myelopathie), kadi difina dia mu nshingu wa kuinshi didi difikisha maulu makole, matekete ne tshifu tshidi tshinyanguka (Cauda Equina Syndrome), udi ne bua kumona mu lungenyi muaba udi muonji wa mukolo wa muntu ujika:

1. Mutshima wa mukolo (Mukolo wa mu tshiadi ne wa mu tshiadi too ne ku \(L1\)):
2. Mu muntu mukulumpe, tshitupa tshikole tshia munkatshi tshia mukolo tshidi tshipueka ku mutshi wa buongo kupitshila mu mukolo wa mifuba wa mu nshingu (mukolo wa mu nshingu) ne wa munkatshi mua mukolo (mukolo wa tshiadi) ne tshidi tshijika mu tshitupa tshia mukolo tshidibu babikila ne: conus medullaris anu pabuipi ne mukolo wa kumpala anyi muibidi (\(L1\text {\)2) anu kuinshi kuebe tshiadi.
3. Bu mudi muonji wa mukolo muikale ne Upper Motor Neurons (central nervous system tracts), kutshibula muonji muaba wonso kubangila ku nshingu too ne ku \(L1\) kudi kufikisha ku Upper Motor Neuron (UMN) signs: stiff, tight, spastic muscles (hypertonie), brisk anan knee/hyperflexes (**hyperflexes and reflexes clonus), dikasa dinene didi dibanda padibu balenga dikasa (tshimanyinu tshia Babinski tshimpe), dienda dia "kuenda pa matadi" didi kadiyi dimpe, ne mulongo mutoke udi mutangile ku tshiadi anyi ku difu udi kuinshi kua dikoba dienda dinyanguka (tshitupa tshia lungenyi).
4. The Cauda Equina ("Mukila wa Kabalu", kumbukila ku \(L2\) too ne ku Sacrum \(S5\)):
5. Kuinshi kua \(L1\text{ to }L2\) vertebra, kakuena mushipa wa mukolo mukola to. Pamutu pa nanku, tshisumbu tshia miji ya mijilu 18 (\(L2, L3, L4, L5\) ne \(S1, S2, S3, S4, S5\) ku dia bakaji ne ku dia balume) tshidi tshienda munda mua tshibombi tshia mu tshiadi bu mionji ya mukila wa kabalu (cauda equina mu Latin).
6. \(L2\text{ to }S1\) miji ya mijilu idi ipatuka bua kukolesha bitupa bia mubidi, binu, bikono, ne makasa.
7. Miji ya **\(S2, S3,\text{ ne }S4\) idi kayiyi ne myeline **\(S2, S3,\text{ ne }S4\) idi ilonda too ne munkatshi mua mukila wa kabalu bua kukokesha dipatuka dia mu tshifu (dikokangana dia detrusor), diumusha dia mu tshiadi, dia mu tshifu ne tshia mu tshifu, dikokesha dia malu a masandi/dilengeja dia dikoba "saddle" (groin, genital, perineum, ne buttocks).
8. Bualu bua cauda equina udi ne Lower Motor Neurons (peripheral nerve roots) pamutu pa mukolo wa munkatshi, udi utshibula cauda equina (misangu ya bungi udi ufumina ku disama dia central disc herniation ku \(L4\text{--}L5\) anyi \(L5\text{--}S\)1) Neurons Lower Motor (LM) bimanyinu**: mifuba mitekete, mitekete (butekete bua bundu), dipanga anyi dipueka dia tshikasa ne dikasa (areflexia), ne tshifu tshikole, tshitekete tshidi katshiyi mua kupatula mashi.

Difuanyikija dia malu 4 a tshimpitshimpi a dipanda dia mukolo¶

Ingidija tshibambalu etshi tshia luondapu (tshidi tshilondangana ne British Association of Spine Surgeons [BASS], UK GIRFT [Getting It Right First Time] National Suspected Cauda Equina Pathway, ne NICE Guideline NG234) bua kufuanyikija bilumbu binayi binene bia mukolo bidi kabiyi bia njiwu:

Bulombodi bua mu lupitadi bua kuteta Cauda Equina Red Flags kumbelu¶

Babedi badi ne kanyinganyinga kakole ka mu tshiadi batu misangu ya bungi banua manga a kanyinganyinga, batshioke, ne kabayi bamanye ni bimanyinu biabu bidi "anu disama dia tshiadi tshibi" anyi disama dia Cauda Equina dilelela. Ingidija bintu bitanu ebi bia mudimu, bia muakulu mupepele (bianyishibue kudi UK Chartered Society of Physiotherapy [CSP] ne National Back Pain Pathway) bua kudikonkonona wewe anyi muntu wa mu dîku dienu:

1. Diteta dia "Disukula dia mabeji a mu nzubu wa tshilala benyi" bua diondopangana dia tshibandilu (\(S2\text{--}S5\))¶

Diondopangana dia tshibandilu kadiena diumvuija misangu yonso ne: tshiadi tshiebe tshijima tshidi tshifue 100 pa lukama bu dibue dia mutshi to. Ku ntuadijilu kua disama dia Cauda Equina, ditu ditamba kuikala dia patupu anyi dia luseke lumue: - Ebeja mubedi ne: *"Paudi usomba pa tshibasa tshia tshiibi anyi udisukula ne dibeji dia tshiibi panyima pa wewe mumane kusukula anyi mumane kuenza mudimu wa tshisuku, dikoba didi dinyunguluke tshitupa tshia panyima (anus), pankatshi pa maulu ebe (perineum), anyi ku bitupa biebe bia lulelu anyi bia mu nshingu bidiku biumvuika bibi, bienza buôwa, bikole, mashika, anyi bu mudi munganga wa meno mukupeshe dikuba dia nsongo * kayi ne dîyi anyi?" - Tangila kabidi: Kusomba panshi kudi kumvuika bu udi musombe pa dibue, pa tshilamba tshivungame, anyi pa tshiponji bualu kikoba tshidi pa mutu pa mifuba yebe ya kusomba katshiena mua kuikala ne tshimuenekelu tshimpe anyi? Diumvua dionso didi dishintuluka mu tshitupa tshia tshibandilu didi dileja dibendele dikunze dia nzubu wa lupitadi lua tshimpitshimpi.

2. Kumanya bikondo bisatu bia dipanga dia tshiadi tshia Cauda Equina¶

Bu mudi bantu badi ne disama dikole dia mukolo misangu ya bungi bepuka bua kuya mu tshina tshia mâyi anyi kunua manga bu mudi codeine/morphine anyi gabapentin/pregabalin adi abafikisha ku dilala tulu, disama dia tshiadi didi dipua muoyo bipepele. Tangila mashintuluka onso aa: 1. Dijimija dia lungenyi: Kuena kabidi umvua dijinga dia pa tshibidilu dia se: tshifu tshiebe tshidi tshiuwula to, NANSHA paudi usomba pa tshina tshia mâyi ne wela nsukadi, udi mua kumvua nsukadi ituta mâyi adi mu tshina tshia nsukadi, kadi kuena mua kumvua nsukadi wa kapia upitshila mu tshina tshiebe tshia nsukadi to. 2. Motor Hesitancy and Straining: Udi wimana anyi usomba ku tshina tshia mâyi mu minite umue kuyi mua kutuadija kuela mâyi, udi ne bua kuela tshianza tshiebe bikole ne misunya ya mu difu diebe (Valsalva) anyi kufina tshianza tshiebe pa difu diebe dia kuinshi bua kupatula mashi, anyi udi ujikija kuela mashi ne udi umvua diakamue bu ne: tshifu tshiebe tshitshidi tshiuwule tshitupa. 3. Dilama dia mashi kakuyi kanyinganyinga ne dibuela dia mâyi: Kuena mupatule mashi munkatshi mua mêba 6 too ne ku 8 nansha muudi munue mâyi, NANSHA tuishi tukese tua mashi tudi tupatuka mu bilamba biebe bia munda mu tshimpitshimpi paudi ushintulula muaba, ukokola anyi wimana (dipanga dia mashi a bungi difumina ku tshifu tshidi tshitambakane ne tshinyanguke).

3. Bua tshinyi "Sciatica bilatérale" (nansha kayi ne dipanga dia lungenyi) udi dibendele dikunze¶

Mu tshipupu tshia pa tshibidilu tshia herniated disc, tshitupa tshikese tshia jelly tshidi tshipatuka kakese ku dia bakaji anyi ku dia balume, tshikuma muji umue wa nerve ne tshikebesha sciatique wa ku luseke lumue wa kale ku dikasa dimue. - Ino, shi mubedi udi na disama dia mu nshingu, nsongo, nansha disama dia tshiadi didi dipuekesha maulu onso abidi musangu umo, NANSHA yeye muikale ne disama dia tshiadi dia balume lumingu lujima ne yeye mupete disama dia tshiadi dia balume lelu (disama dia tshiadi didi dishintuluka), bidi biumvuija ne: dibutuka dinene dia mu tshiadi didi diuja tshitupa tshia munkatshi mua tshiadi tshijima ne didi mua kunyangakaja equina bundle.

4. Mushindu kayi wa kuenza tshikebelu tshia 10-sekonde tshia ku luseke lua bulalu tshia kuendakana ne ku makasa¶

Shi mubedi udi mua kuimana bimpe ne muntu udi umona diboko diende, umulombe bua kuenza ntambue 3 pa bikasa biende ne ntambue 3 pa nsongo ya makasa ende: - Kabena mua kuenda pa bikasa biabu (minwe idi ikuluka panshi = "Dikuluka dia makasa"): Bidi bileja dikuma dia \(L4\text{ ne }L5\) miji ya mijilu idi ilombola dishintuluka dia tshiadi (mushipa wa kumpala wa tibialis) ne dilengeja dia tshiadi tshinene (extensor hallucis longus). - Kabena mua kujuka anyi kuenda pa mitu (tshikasa tshidi tshipueka panshi): Bidi bileja dikuma dia \(S1\text{ ne }S2\) miji ya mijilu idi ilombola mushipa wa tshiadi (gastrocnemius-soleus plantarflexion). - Butekete budi buenda bukola lukasa mu dikasa dionso, anyi butekete mu maulu onso abidi, budi bulomba dikonkonona dia lukasa dia tshibambalu tshia malu a mpukapuka ne MRI, nansha mudi mudimu wa tshiadi utshidi anu muimpe.

Kumvua bikondo bibidi bia disama dia Cauda Equina: CES-I ne CES-R¶

Baminganga ba mukolo ba pa buloba bujima batu bateka disama dia Cauda Equina Syndrome mu bitupa bibidi bishilangane bidi bileja mushindu wa kupanda muntu:

Malu a pa buawu adi ne njiwu mikole: Kansere (MSCC) ne tshipupu tshia mu tshiadi¶

1. Ditangalaka dia muonji wa mukolo (MSCC) kudi babedi badi ne disama dia kansere dia mpindieu anyi dia kale¶

Pabuipi ne 5 too ne ku 10 pa lukama ya babedi bonso badi ne disama dia kansere (nangananga dia mabele, dia tshiadi, dia mu mikolo, dia tshiadi, dia tshiadi, dia lymphome, anyi dia multiple myeloma) badi ndekelu wa bionso bapeta disama dia kansere mu mifuba ya mukolo. Padi tshimpumpu tshikola mu mukolo wa mukolo anyi tshienza bua mukolo mutekete ukuluke pa muonji wa mukolo: - Disama didi dilua mbingu mikese kumpala kua disama dia tshiadi: Bantu bapite pa 90 pa lukama batu bapeta disama dipiadipia anyi didi dienda dikola mu mukolo anyi mu nshingu munkatshi mua mbingu 3 anyi 8 kumpala kua maulu abu kuteketa mu tshimpitshimpi. - Disama dia mukolo dia kansere dia kale: 1. Disama mu mukolo wa tshiadi (munkatshi mua tshiadi pankatshi pa maboko): disama dia tshiadi didi kadiyi ditamba kuenzeka mu tshiadi, nunku disama dipiadipia dia munkatshi mua tshiadi kudi muntu mukole udi ne bidimu bipite pa 50 anyi kudi muntu yonso udi ne disama dia kansere didi mua kuikala ne mpata too ne padibu baleja ne: ki mmuomu to. 2. Disama dia butuku / dia mu tshiadi: Disama dia mukolo dia pa tshibidilu didi diumvuika bimpe paudi ulala panshi pa bulalu bua kuikisha. Disama dia tshimpumpu munda mua mukolo ditu dikola bikole padi muntu mulale pa bulalu butuku (bua dibuela dia mijilu munda mua mufuba) ne didi dijula ​​mubedi ku tulu. 3. Disama dia mu tshiadi didi difuanangane ne tshilamba: Disama didi dinyunguluka bikole mu tshiadi anyi mu difu bu mukaba. - Tshienzedi tshia kumpala kua lupitadi ne tshia ER (NICE NG234): - Shi MSCC udi wela meji ne udi ne bimanyinu bia mu lungenyi (bulema bua ku makasa, dienda dia tshianana, dishintuluka dia lungenyi, anyi lutatu lua mu tshifu), teka mubedi panshi diakamue bua bukole budi bukokela bintu pa buloba kabunyanyi mukolo udi kayi mushindame udi mutekete bua tshimpumpu to. - Ndaku diakamue mu nzubu wa lupitadi bua kuenza MRI wa mukolo mujima mu mêba 24 ne diakamue dexamethasone (\(10\text{ to }16\text{ mg}\) stat) bua kukepesha disama dia tshimpumpu tshia mukolo kumpala kua diondapangana ne radiation anyi dipanda dia mukolo.

2. Spinal Epidural Abscess (SEA) ne Spinal Epidural Hematoma (SEH)¶

• Spinal Epidural Abscess (SEA): Tshibombi tshia pus wa bactérie tshidi tshisangisha munda mua tshina tshia mifuba tshikole. Classic Triad: (1) Disama dikole, dia muaba umue, dia mukolo, (2) Kapia anyi mashika (manya ne: Kapia kadienaku mu bantu batue ku 40 pa lukama badi basama ku ntuadijilu), ne (3) Dipanga dia mitu didi dienda dikola lukasa. Nnganyi udi mu njiwu? Muntu yonso udi ne disama dia diabete, disama dia dikoba dia matuku mashale aa/disama dia selulite, disama dia meno, disama dia mu njila wa masuba, dikuatshika dia manga mu mushipa, hemodialyse, anyi diela dia steroïde/spinal tap dia matuku mashale aa. Padi butekete bua ku makasa butuadija ku disama dia epidural, paraplegie mujima udi kayi mua kupingana udi mua kuenzeka mu mêba 6 too ne ku 24 padi disama edi dijika mashi a mu mikolo.
• Spinal Epidural Hematoma (SEH): Tshipupu tshia mashi tshidi ne bukole bua bungi mu tshina tshia mukolo, tshidi tshikuata mubedi udi wangata malu adi atekesha mashi (warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel, anyi heparin) uvua muenze tshipupu tshia lumbar/epidural catheter anyi mupete tshipupu/tshipupu tshia tshimpitshimpi. Udi umueneka bu disama dia mukolo dia lukasa bu dia muele didi dilonda mu mêba makese kudi disama dia maulu ne dipanga dia mashi; bidi bikengela dishintulula dia lukasa dia manga adi akanda mashi ne diumusha dia mitu.

Tshidi tshienzeka mu lupitadi: Dipima dia tshiadi ne MRI wa lukasa¶

Kumanya tshitudi mua kutekemena mu lupitadi kudi kuambuluisha babedi ne bena mu mêku bua kuikala bajadike ne: kakuena tshintu tshidi tshipangila mu nzubu wa lupitadi udi ne mudimu wa bungi to:

1. Dikebulula dia mitu ne tshikebelu tshia panyima pa dipanga dia tshintu (PVR) tshia ultrasound tshia mu tshiadi:
2. Tshia kumpala, munganga wa tshimpitshimpi neatete bukole bua maulu, mushindu udiye wenza malu, ne diumvua dia dikuma dia maulu ebe ne muaba wa tshibandilu. (Note: Modern UK BASS/GIRFT guidelines emphasize that digital rectal exam [DRE] bua kukontonona tone wa mu tshifu udi ne bukole bukese menemene; kuikala ne "mutoyi wa tshifu tshia pa tshibidilu" KAKUENA kumbusha disama dia Cauda Equina to, ne MRI udi anu ne tshia kuenzeka padiku bimanyinu bikunze)
3. Pashishe, nebakulombe bua kuteta kuela tshifu tshiebe tshijima mu tshina tshia mâyi, ne munganga neateke diakamue tshiamu tshia ultrason tshidi katshiyi tshisama pa difu diebe dia kuinshi bua kupima Post-Void Residual (PVR) urine volume. Bungi bua bintu bidi bishala kunyima kua tshianana bipite pa \(200\text{ mL}\) (ne nangananga \(> 400\text{ too ne ku }500\text{ mL}\)) budi tshimanyishilu tshikole tshia dilama dia tshiadi tshia mu mifuba, kadi PVR \(< 100\text{ too ne ku 200\text{ mL}\) udi uleja ne: (nansha mudi CES-Incomplete mua kuikalaku ne PVR mukese pikala disama dia tshiadi anyi sciatica wa ku luseke lubidi dikalaku).
4. Gold-Standard Emergency MRI Scan (Not an X-Ray or Plain CT):
5. Biamu bia X-ray bia mukolo kabiena mua kumona diske, mijilu, anyi muonji wa mukolo nansha kakese, ne biamu bia CT bidi kabiyi ne dishilangana bidi bipua too ne ku 30 anyi 50 pa lukama bia dikuma dia cauda equina ne dia epidural abcesses. Dipima dia tshiamu tshia nzembu (MRI) dia mukolo wa tshiadi anyi tshia mukolo mujima ke tshikebelu tshia mushinga mukole tshia or. (Bikala mubedi ne tshiamu tshia mudimu tshidi katshiyi tshikumbanangana ne MRI anyi tshiamu tshia mitaku, baminganga badi benza CT Myelogram wa lukasa.)

Mukanda wa diyukidilangana mulelela bua disungula dia lupitadi ne EMS¶

Bu mudi nzubu ya luondapu ya lukasa lukasa imona bantu ba bungi badi ne disama dia tshiadi tshia kuinshi tshikondo tshionso, kuleja patoke Bendele bikunze biebe ku biro bia disungula kudi kukupangisha bua kuikala mu nkuasa wa kuindila udi kayi ne mushinga wa bungi munkatshi mua mêba a bungi:

"Ndi muaba ewu ne disama dikole dia mukolo anyi dia ku makasa diakatuadija mu [Dituku], kadi mu [Dîba dilelela dia lelu] ngakapeta [dipanga dia lungenyi mu tshitupa tshianyi tshia ku makasa/tshia ku tshiadi tshianyi pamvua nsukula / lutatu lua kutuadija kuela mashi anyi / sciatica ne butekete mu maulu anyi onso abidi / muyuki wa kansere ne dienda dipiadipia dipanga dishindame]. Ndi ne kanyinganyinga bua Equiudaeal Syndrome [Caudaeal Corn. Dikuma] ne ndi dijinga ne tshikebelu tshia lukasa tshia tshifu ne tshikebelu tshia MRI tshia lukasa. Ndi mudilame Nothing by Mouth (NPO) bua meme kuikala dijinga ne dipanda lelu."

Nkonko itubu bela misangu ya bungi¶

Shi nkidipo (tshiyi mua kudikanda), bidiku biumvuija ne tshiena ne disama dia Cauda Equina anyi?¶

Tòo, kuindila dipanga dia tshisumi ke bualu bumuepele budi buenza bua babedi bapangile dîba dia kuondopibua bimpe padibu babapanda. Bu mudi Cauda Equina Syndrome unyangakaja mijilu idi ifinya tshifu, tshimanyishilu tshia kumpala tshia tshifu ntshia dielakana dia tshifu, dipanga dia tshifu, dijimija dia lungenyi lua tshifu, anyi dipanga dia kukokesha (dilama); dipatukila dia bushuwa (dipanga dia kulama mâyi) didi dienzeka anu pashishe padi tshifu tshidi tshinyanguke tshikola too ne paditshi tshikumbana, ne dîba adi dinyanguka dia kashidi dia mijilu dikadi dienzeke misangu ya bungi.

Tshiamu tshia X-ray tshia mukolo tshia pa tshibidilu anyi tshiamu tshia CT tshia pa tshibidilu tshidi mua kumbusha disama dia Cauda Equina anyi?¶

Aa, tshiamu tshia X-ray tshia mukolo tshidi tshileja anu mifuba mikole ne katshiena mua kumona disques herniées, miji ya nerve pinched, epidural abscesses, anyi tumors ya mu mukolo nansha kakese. Nansha tshiamu tshia CT tshidi katshiyi ne dishilangana tshidi mua kupua muoyo bipeta binene bia mubidi mupepele anyi dikuma dia muonji wa mukolo wa kumpala; tshikebelu tshia MRI tshia lukasa tshia mukolo (anyi CT myelogramme shi udi ne tshiamu tshia luondapu tshidi katshiyi mua kubuela mu MRI) ke tshikebelu tshimuepele tshia kueyemena tshia kujadika anyi kubenga disama dia Cauda Equina.

Bua tshinyi munganga wakangambila bua kubenga kudia anyi kunua tshintu nansha tshimue pamvua nya mu nzubu wa lupitadi lua lukasa bua disama dia mukolo ne disama dia tshiadi?¶

Shi tshikebelu tshieba tshia MRI tshia lukasa tshileja disama dia Cauda Equina anyi disama dia mukolo wa mukolo, munganga wa mukolo udi ne tshia kukuangata buludiludi mu nzubu wa dipanda bua kukupanda mu tshimpitshimpi ne anesthesie wa tshimpitshimpi. Shi udi na bya kudya nansha mayi mu difu diebe, kukuteka mu anesthésie générale kudi ne njiwu mikole ya kuela mu mikolo yebe (aspiration), bidi mua kuenzeja baminganga bua kulekela dipanda diebe dia mukolo didi dilomba dîba dia bungi bua mêba a bungi.

Bidiku bimpa bua kuya kumona munganga wa mifuba, munganga wa mifuba, anyi munganga wa mubidi bua kulongolola mukolo pandi ne disama dia sciatica anyi disama dia tshiadi anyi?¶

Tòo, dishintulula dia mukolo, dilongolola dia lubilu lua bungi, dikoka dia mesa, anyi diolola dia bukole bidi bibengangana bikole padiku tshimanyinu kampanda tshia dibendele dikunze (bu mudi disama dia tshibandilu, dishintuluka dia tshifu, sciatica wa ku luseke lubidi, dikuluka dia makasa didi dienda dikola, kapia, anyi disama dia kansere). Kuenza mudimu ne mukolo udi kale ne disama dia tshitupa tshia munkatshi anyi tshimpumpu tshidi tshifina ku cauda equina anyi ku muonji wa mukolo kudi mua kutshibula diakamue mionji ya mijilu idi mishale ne kuenza bua muntu ikale ne disama dia kashidi.

Miaba mifumina¶

• British Association of Spine Surgeons (BASS), Society of British Neurological Surgeons (SBNS), and NHS England GIRFT (Getting It Right First Time) Programme (United Kingdom): National Suspected Cauda Equina Syndrome (CES) Pathway (2023/2024 consensus guideline on recognition red flag, post-voidal scan thresholds, ne 4-hour emergency MRI turnaround).
• National Institute for Health and Care Excellence (NICE, United Kingdom): Spinal Metastases and Metastatic Spinal Cord Compression: Diagnostic and Management (NICE Guideline NG234, supine positioning for suspected unstable MSCC, 24-hour MRI, and dexamethasone protocols) and Low Pain and Bacias in Over: 16 Dikonkonona ne dilombola* (NG59).
• American College of Radiology (ACR) ne North American Spine Society (NASS, United States): ACR Appropriateness Criteria: Low Back Pain and Acute Spinal Cord Compression / Cauda Equina Syndrome.
• Chartered Society of Physiotherapy (CSP) and Musculoskeletal Association of Chartered Physiotherapists (MACP, United Kingdom): Cauda Equina Syndrome Credit-Card Red Flag Safety Net Patient Information Guide.
• Congress of Neurological Surgeons (CNS) and American Association of Neurological Surgeons (AANS, United States): Clinical Practice Guidelines on the Timing of Surgical Decompression for Cauda Equina Syndrome (CES-Incomplete vs. CES-Retention) and Spinal Epidural Abscess.

Malu adi apetangana¶

• Disama dia mukolo: disama dia nshingu ne dia mukolo
• Dysreflexie autonomique mu disama dia mukolo wa mukolo mu lupitadi lua lukasa
• Mifuba mityumuke, mifuba mityumuke, ne mifuba mityumuke diambuluisha dia kumpala
• Dijingulula dia tshipupu (FAST) ne diandamuna dia tshimpitshimpi
• Disama dia sepsis ne dia septic shock