Funicular spinal disease is caused by:
- 1. vitamin B12 deficiency
Vitamin B12 deficiency can be caused by insufficient intake, impaired absorption, impaired utilization (e.g. by cytostatic drugs, congenital disorders in folic acid metabolism) and by increased consumption (Berlit 2011).
This can be caused by, for example:
- nutritional deficiency
- Intestinal diseases including fish tapeworm infestation, fungal infestation of the intestine (Hacke 2019).
- metabolic disorders with disturbed vitamin B12 utilization
- Decreased production of gastric acid (occurs preferentially in the elderly)
- Drug-induced by e.g. proton pump inhibitors (Gröber 2013), anticonvulsants, biguanides, hydantoins, calcium-binding substances, phenylbutazone, nitrofurantoin, cytostatics (Hacke 2019)
- Alcohol abuse (Kasper 2015)
- Anorexia nervosa (Berlit 2011)
- Malabsorption in e.g., atrophic gastritis with e.g., deficiency of anti-intrinsic factor, autoantibodies against occupant cells (parietal cells) (Wolpert 2015)
- Nitrous oxide abuse (Wolpert 2015)
- Following bariatric surgery (Dudorova 2015)
- Z. n. gastrectomy (Hacke 2019)
- 2. folic acid deficiency
This occurs preferentially in e.g.:
- Pregnancy
- lactation
- chronic alcoholics (Ende- Henningsen 2018)
- 3. copper deficiency (Hacke 2019).
This can occur in the context of the following diseases:
- Wilson's disease
- malnutrition
- Zinc overdose
- Menkes syndrome
- intestinal malabsorption (see copper)
Risk groups for Vit. B12 deficiency are:
- vegetarians and vegans
- Increased need for Vit. B12, e.g. in autoimmune diseases, HIV-infected persons, pregnant women, etc.
- chronic kidney diseases
- gastrointestinal diseases
- Long-term therapy of e.g. metformin, H2 blockers, proton pump inhibitors (Gröber 2013)