坐骨神经痛1000例分析

多年所见1000例坐骨神经痛中单侧者863例,双侧者137例,多为慢性起病。病程为20天至15年。全部病例均作1～4次的腰骶、髋关节X线检查,189例作了肌电图,12例进行脊髓碘油造影,3例经过CT检查,除45例无异常发现外,其余955例均有阳性发现,分别为肥大性脊椎炎474例,急性腰椎间盘突出332例,强直性脊椎炎44例,腰椎骶化22例,骶椎隐裂18例,椎弓崩解12例,梨状肌综合征12例,压缩性骨折12例,骶椎腰化10     

隐球菌性脑膜炎并骨损害1例报告

我科自 1970年以来共收治隐球菌性脑膜炎 (隐脑 ) 15 0例 ,其中 2例合并骨损害 ,现将最近的 1例报道如下。1　病例　男 ,17岁。间歇性头痛 1年伴腰痛、发热 1月余 ,于 2 0 0 0年 1月 7日入院。患者 1年前出现头痛伴恶心呕吐 ,无发热 ,无特殊治疗。 10个月后头痛再发并加重伴发热 (38.5℃ ) ,4天后出现嗜睡、短暂意识障碍 ,并出现腰骶痛 ,向双下肢放射。当地医院腰椎 X片示 :L1 、L2 椎体破坏 ,椎旁冷脓肿 ,诊断为结核性脑膜炎、腰椎结核。予抗结核、地塞米松 (10mg/ d)等治疗 ,头痛、腰痛无缓解 ,腰穿测脑压为 8.82 k Pa。拟中枢神经系统…     

骶部硬脊膜外囊肿1例报告

我院于1977年收治1例骶部硬脊膜外囊肿,术前曾误诊为骶骨肿瘤,手术时始得确诊。故予报道。 患者 男,41岁,1977年3月2日住院。患者于20多天前夜间突然发生尿潴留,入院前三天出现尿失禁及肛门周围麻木,并觉两下肢走路无力,发凉,无下肢放射痛及腰背痛。住院后拍片显示骶骨有膨胀性骨质破坏,初诊脊索瘤后疑为骶椎管内肿瘤。7年前曾有下腰部痛,诊断为隐性骶裂,未作进一步检查。 检查:脊柱无畸形,骶部不隆起,腰骶部无压痛     

脊髓纵裂畸形1例报告

患者女性39岁,1年前,自觉双下肢无力,活动不灵活逐渐加重,近半年感双腹殷沟疼痛。体格检查:发育尚可,心、肺正常,腹软,肝脾未及,胸椎轻度后凸畸形,腰背部见一撮毛发,骶部正中见一皮肤陷窝。双下肢肌力Ⅳ度,双膝反射++,双踝反射(-)感觉无异常,双侧 Babinski 征阴性。诊断腰骶神经根病变。影像学诊断:腰椎平片示胸腰椎后凸畸     

神经传导速度、H反射、肌电图联合检测对诊断腰骶神经根病变的意义

腰骶神经根病变:主要是由椎管内和脊椎病变所致,其中以腰椎间盘突出最为常见[1]。现将2005年10月～2007年10月我院门诊及住院30例腰骶神经根病变患者应用神经传导速度、H反射、肌电图检查联合诊断腰骶神经根病变的神经电生理结果报告如下:资料和方法1临床资料30例患者中男性20例,女性10例。年龄30～75岁,平均年龄53.5±13.8岁,病程7.5±1年。全部病例均有患侧下肢放射性疼痛、麻木、温痛觉减退,其中有3例患者患肢背屈受限,胫前肌有肌肉萎缩,有1例患者患肢足下垂,胫前肌肌肉萎缩明显。有6例患者患肢跖屈受限,腓肠肌肌肉萎缩。20例患者直腿抬高实验(+)。2例患者腰椎X线平片示腰椎不同程度骨质增生。15例患者CT显示2例腰椎退行性变,8例腰4、5及腰5骶1椎间盘突出,5例腰5骶1椎间盘突出。13例患者MRI显示4例病人腰椎不同程度椎间盘膨出,6例病人腰4、5及腰5骶1椎间盘突出,3例病人腰5骶1椎间盘突出。腰骶神经根包括腰1-5(L1～L5)神经根,骶1-5(S1～S5)神经根和1条尾神经根,在绝大多数病人腰椎间盘突出多累及L4/L5椎间隙和L5/S1椎间隙而累及L3/L4椎间隙者少见,对于其他较高或...     

局部生物力学因素在L5/S1椎间盘突出症发病中的作用

背景：近年来,有关生物力学因素与腰背痛关系的报道大多集中在腰椎整体生物力学与腰背痛的研究上,而针对局部生物力学特点与单纯腰椎间盘突出的研究则较少。 目的：探讨局部生物力学因素在L5/S1椎间盘突出症发病中的作用。 方法：共纳入对象124例,包括椎间盘突出症组和对照组,62例/组。椎间盘突出症组为2008-06/2009-07于青岛大学医学院附属医院诊断明确并行手术治疗的L5/S1椎间盘突出症患者;对照组为健康体检人员。在腰椎正侧位X射线片上测量和观察各组L5椎体相对深度、腰骶移行椎、L5/S1椎间盘相对高度、腰骶角、骶骨水平角和骶骨垂直角的变化。 结果与结论：与对照组比较,椎间盘突出症组L5椎体相对深度明显增加(P < 0.01),椎间盘突出症组腰骶移行椎数目明显降低(P < 0.01),说明相对位置较深的L5椎体及腰骶移形椎可能对L5/S1椎间盘具有保护作用,可降低L5/S1椎间盘突出症的发生率。椎间盘突出症组腰骶角和骶骨水平角明显减小(P < 0.01);但L5/S1骶骨垂直角和椎间盘相对高度在椎间盘突出症组与对照组之间差别无显著性意义(P > 0.05),可见,L5/S1椎间盘相对高度、腰骶角、骶骨水平角和骶骨垂直角与椎间盘突出的关系仍不明确,需进一步探讨。     

小儿骶尾部巨大畸胎瘤合并脊膜膨出1例

1临床资料患儿女4个月,出生时发现骶尾部肿块,逐渐增大,于1990年3月20日住院治疗。检查:神志清楚,营养发育中等,体重5.6kg,头形大小正常,前囟尚未闭合,压力正常。双瞳孔等大,光反射存在,眼球运动正常。心肺与腹部检查正常,四肢活动良好。腰骶尾区有20cm×18cm×16cm大小肿块,上部呈囊性,下部为实质性。脊柱X线正侧位片:腰骶尾部有儿头大小软组织块影,呈分叶状,内有不规则钙化影,腰椎椎体发育稍差,未见其他畸形。入院诊断:骶尾部巨大畸胎瘤。术前化验检查:血、尿常规及肝肾功能均正常。手术时,患儿取侧俯卧位,常规消毒铺巾,肛内填塞凡士林纱…     

腰骶部椎管内角质化肿瘤1例

1 病历摘要(图1) 女,33岁;因双下肢麻木、放射痛1年余,加重伴行走不便3周于2011年6月入院.查体:腰骶椎外观无明显畸形,骶髂关节压痛及叩击痛,双下肢麻木伴放射痛,双下肢肌力V级.腰骶椎MRI显示:L5～S1椎间隙水平椎管硬脊膜下见一纵向卵圆形团状影,大小约1.0 cm×0.8 cm×1.9 cm,边缘光滑,T1WI稍低信号,T2WI稍高信号,脂肪抑制序列高信号,增强扫描轻度强化,边缘见线状各序列低信号包膜影.     

椎管内上皮样囊肿

一、临床资料与结果男１６例,女１１例;年龄４～５８岁。病程２个月至１４年。肿瘤位于脊髓内１０例,髓外硬膜内１７例;位于颈段２例,胸段１０例,腰骶段１５例。临床表现：四肢麻木无力２例,双下肢麻木无力１８例,双下肢肌肉萎缩１３例,大小便障碍、痛觉减退１６例,病理征存在９例,双下肢屈曲畸形３例,足内翻畸形４例,皮毛窦２例,腰骶椎屈曲畸形３例。脊柱Ｘ线证明有骶椎隐裂５例。脊髓碘油造影５例,均显示梗阻端肿瘤所形成的充盈缺损。ＣＴ检查２２例,显示椎管内均一低密度病灶,边界清楚,相应部位椎管增宽。ＭＲＩ检查１…     

CT神经同层显示技术诊断腰骶神经根变异分析

目的观察分析CT神经同层显示技术在腰骶神经根变异诊断中的应用价值。方法选取2018年7月至2020年4月期间在郑州市第七人民医院因腰腿痛行腰椎检查的55例患者,均采用64排螺旋CT机设备进行常规腰椎容积扫描,之后进行常规图像重组与神经重组,并分别观察患者腰骶神经根形态。对存在变异的神经根按照坎贝尔骨科手术学标准分型。结果研究分析发现:①55例患者中52例患者图像比较满意,其中常规图像与神经重组图像各发现腰骶神经根变异2例与7例,显示率分别占4%与13%,两者之间差异有统计学意义(P<0.05);②在7例变异神经根中,按照坎贝尔骨科手术学标准分为Ⅱ型变异6例,Ⅴ型变异1例,各占86%与14%。结论对因腰腿痛行腰椎检查的患者,采用CT神经同层显示技术可对患者的神经根变异形态、走形等完整、直观地显示,在临床上诊断腰骶神经根变异属于优选方法,很有参考价值。     

Magnetic resonance evaluation of spinal dysraphism in children

Magnetic resonance (MR) imaging of the spine was performed as the initial imaging technique in 20 children when spinal dysraphism was suspected clinically and plain radiographs showed spina bifida. The correlation with surgical findings indicated that MR provided accurate information preoperatively in all the cases. Some unusual observations in cases with spina bifida cystica and occulta are discussed. It is concluded that plain radiograph and MR complete the preoperative radiologic evaluation of cases with spinal dysraphism.     

Neurological and medico-social problems of spina bifida patients in adolescence and adulthood

Chronological changes in the neurological manifestations of spina bifida are well recognized in the early developmental periods: fetal, neonatal, infantile, pre-school and school life. However, little has been written about the medical and medico-social problems of spina bifida patients in adulthood. Patients now in this age group had the condition diagnosed and managed in an era when modern neurosurgical concepts were only just beginning to be established with the aid of invasive methodology. In our series of 141 cases of spina bifida, 18 patients (13.5%) were over 16 years of age. These included 9 cases each of spina bifida aperta (myeloschisis) and spina bifida occulta (spinal lipoma). The ages ranged from 16 to 47 years (mean: 23.5 years) in the former and from 16 to 57 years (mean: 29.2 years) in the latter group. During the long-term follow-up with quantitative analysis of the spinal neurological changes using the spina bifida neurological scale (SBNS), the final outcomes appeared very grave. Except for 1 case in each group-1 grade III in the spina bifida aperta group and 1 grade II in the spina bifida occulta group-all patients over the age of 27 years were classed as having grade IV disease. There were 2 patients with spina bifida aperta in whom postoperative paraplegia appeared after delayed radical repair (at the ages of 3 years and 18 years) and 3 patients with spina bifida occulta in whom obvious neurological deterioration was observed as the natural history with ongoing paraparesis at the spinal level or late onset of sexual problems. The other group included 2 patients with spinal lipoma in whom late neurological deterioration was observed and who were obliged to undergo a second operation in spite of aggressive early procedures performed during infancy. Among the patients with spina bifida aperta, 2 had marked ventriculomegaly as a form of long-standing overt ventriculomegaly in the adult (LOVA). After the CSF shunt procedure both these patients had problems with delicate shunt dependence and requested fine shunt flow regulation. Two patients in this group also suffered from severe depression. This study involves a limited number of patients, but it may be useful for reference on various points: (1) future prospects for the management of pediatric cases of spina bifida as practiced in the majority of hospitals; (2) natural histories of untreated cases and surgical indications for preventive procedure in spinal lipoma in early infancy; and (3) internationally differing levels of management of spina bifida and the historical development of individual countries' approaches to the problems.     

Congenital monomelic neurogenic disorder with calf muscle hypertrophy

An 8-year-old girl had hypertrophy of the right calf muscle since birth, with progressive ankle contracture and mild muscle weakness. Her right leg was 3 cm shorter than her left. Electromyography and biopsy of the affected muscle showed neurogenic changes. She also had neurogenic bladder and spina bifida occulta at the S1 level. We believe that the spina bifida was responsible for the neurogenic changes in her right calf, but could not find definite evidence for this association. Although cases with neurogenic muscle hypertrophy, especially calf muscle hypertrophy, have been reported, none of them was congenital or associated with spina bifida occulta.     

Rare Combination of Spinal Lesions and Spina Bifida Occulta: Case Report

An infant presented with spina bifida occulta and a rare combination of spinal lesions, consisting of fibrous band with skin tag, lipoma, congenital dermal sinus and arachnoid cyst. The literature concerning the arachnoid cyst in occult spinal dysraphism is reviewed and the embryogenesis of these lesions is discussed.     

Spinal cord anchored at S2 level: diagnosis difficulties and risks

Anchoring of spinal cord at S2 level is described in a female patient aged 46, associated with bilateral equinovarus deformity and spina bifida in lumbar segment. The onset of the disease was sudden due to prolapse of intervertebral disc at L2-L3 and L3-L4 levels followed by bilateral flaccid-spastic paraparesis. In view of congenital spinal deformity lumbar tap was abandoned and MRI was carried out which showed spinal cord reaching down to S2 level. Diagnostic and therapeutic management is described and literature review is presented.     

Malformations of the spinal cord in 53 patients with spina bifida studied by magnetic resonance imaging

The incidence of associated malformations of the hindbrain and spinal cord in patients with spina bifida was investigated by a clinical and magnetic resonance study. The incidence of these malformations in combination with spina bifida was 49/53 (92.5%). Fiftytree children born with spina bifida aperta (40 patients) or spina bifida occulta (13 patients) formed the study group. The incidence of the various malformations were: Chiari malformations, type I, 10/53 (19%), and type II, 20/53 (38%); syringomyelia, 13/53 (24.5%); hydromyelia 4/53 (7.5%); tethered cord malformation, 35/53 (66%); diastematomyelia 2/53 (4%). Thirty-seven of the 49 patients with associated malformations had no clinical signs at the time of our study. The results point to the fact that in the pediatric age group, associated spinal defects often remain asymptomatic.     

Spina Bifida Occulta as a Relative Contraindication for Percutaneous Retrograde Lead Insertion for Sacral Nerve Root Stimulation

Percutaneous retrograde lead insertion for sacral nerve root stimulation is a newly described technique being applied to a variety of pain disorders. The success of the procedure rests in a defined epidural space such that there is unimpeded progression of the lead into the desired location. It is hypothesized that any condition that results in anatomic compromise of the epidural space would prevent the success of the procedure. Two patients with biopsy‐proven interstitial cystitis and intractable pain were referred to the senior author for evaluation. Percutaneous retrograde lead insertion for sacral nerve root stimulation was performed on these patients in a standard fashion 1 , 2 . Intraoperative fluoroscopy verified the diagnosis of spina bifida occulta. In one patient, implantation was completed percutaneously, but later two of the leads were found to have been placed intradurally. In another patient, repeated attempts at passing the epidural lead distal to the congenital defect were unsuccessful, and the percutaneous procedure was aborted. In conclusion, we have found that the diagnosis of spina bifida occulta, or any other condition in which the epidural space is anatomically disrupted, is a relative contraindication for this procedure. Preoperative roentograms of the lumbar spine may be helpful in avoiding technical difficulties due to this diagnosis.     

Human tail: nature's aberration

Human tail refers to a congenital cutaneous appendix protruding from the lumbosacral region. It is usually associated with an underlying spina bifida occulta, a form of spinal dysraphism. A contiguous fibrolipoma can sometimes be seen extending from the subcutaneous portion of the tail into the inferior spinal cord, resulting in tethered cord syndrome. Management of such lesions includes complete neurologic examination and magnetic resonance imaging. Early diagnosis and microsurgical intervention can prevent development or progression of severe neurologic defects in later life.     

Secondary impairments in young adults with spina bifida

The aim of this study was to examine the prevalence of secondary impairments in young adults with spina bifida and to relate the prevalence to the type of spina bifida and the level of lesion. This cross-sectional study is part of the ASPINE (Adolescents with Spina Bifida in the Netherlands) study. Data were collected on medical history, hydrocephalus (shunt: yes/no), neurological level of lesion (International Standards for Neurological and Functional Classification of Spinal Cord Injury), visual acuity (Landolt rings), spasticity (Modified Ashworth Scale), contractures (range of motion), scoliosis (deviation from perpendicular), ambulation (Hoffer criteria), pressure sores and blood pressure (physical examination), epilepsy, pain, incontinence and sexuality (questionnaire), and cognitive functioning (Raven Standard Progressive Matrices). In total, 179 patients with spina bifida participated (41% male, age range 16 to 25 years, mean 20 years 9 months, SD 2 years 11 months). These were 37 patients with spina bifida occulta, 119 patients with spina bifida aperta and hydrocephalus (AHC+) and 23 patients with spina bifida aperta without hydrocephalus (AHC-). Of our patient group, 73 had a high-level lesion (L2 and above), 68 a mid-level lesion (L3 to L5), and 38 a low-level lesion (S1 and below). Both subdivisions were strongly related with patients with higher lesions more often having hydrocephalus. Most secondary impairments were found for patients with AHC+, and patients with AHC- were mostly comparable to patients with spina bifida occulta. According to level of lesion, most medical problems were found in the high-level lesion group. However, all subgroups suffered from health problems.     

Leg dysfunctions in a hatched chick model of spina bifida aperta

We created chicks with spina bifida aperta (SBA) by incising the roof plate of the neural tube of embryos at Hamburger and Hamilton stage 18 or 19. Incision over the length of three somites caused spina bifida occulta (SBO)-like malformation in 47% of the hatchlings. Incision over the length of five and seven somites caused SBA-like malformation in 100% of the hatchlings. The SBO chicks exhibited no symptoms, whereas the SBA chicks exhibited paralysis of a leg muscle and imbalance between an agonist and an antagonist leg muscles. Lesions in these SBA chicks were located in the spinal segments that give rise to motor neurons that innervated the dysfunctional muscles. Histological analysis revealed that there were fewer small spinal neurons (interneurons) at the site of the lesion in SBA chicks than in the normal chicks and that there was no such difference in the number of the large spinal neurons (motor neurons). Leg dysfunctions in this model of SBA may be attributable to the smaller number of interneurons in the spinal segments that contain motor neurons that innervate the dysfunctional muscle. This model may facilitate studies of the pathological mechanisms that lead to leg dysfunctions in SBA chicks.