硬膜内椎间盘突出症2例报告与文献综述

硬膜内型腰椎间盘突出(intradural lumbar disc herniation, ILDH)是一种少见的腰椎间盘突出类型,占全部椎间盘突出的0.26%～0.3%,常有神经根性症状和马尾综合征。本文报道2例术前怀疑IDDH,病理检查证实为IDDH的患者,对国内外文献进行复习,对其病史、症状、临床表现、影像学特点、手术方式、预后进行总结,为该病的诊疗提出建议。     

硬膜内腰椎间盘突出症

目的 探讨硬膜内腰椎间盘突出症的诊断与手术治疗方式,并对其发病机制进行讨论.方法 对5例硬膜内腰椎间盘突出症患者进行了手术治疗,男3例,女2例,年龄28～52岁,平均42岁,并经CT、MRI和手术证实,手术中采用半椎板切除或全椎板切除术,切开硬脊膜和蛛网膜,显露突出的椎间盘髓核组织,并仔细予以摘除,缝合硬脊膜切口,用脂肪、肌肉、或纤维蛋白凝胶覆盖.结果 尽管患者术前都有明显的神经症状,术后患者都取得了良好的效果,对病人进行了1～5年的随访,术前腰痛、下肢痛均缓解,明显改善了工作和生活质量.3例患者效果良好,恢复了原工作,其他2例患者术前出现了马尾综合征,仍残留一些神经症状,尿频尿急,会阴部感觉丧失,肌肉萎缩.结论 硬脊膜腹侧与后纵韧带粘连是造成硬膜内腰椎间盘突出的主要因素,硬膜内腰椎间盘突出术前很难诊断,通常诊断是在术中确定的,术前诊断应强调MRI的重要性,患者多需要紧急手术,因为神经预后与神经症状出现的时间有关,早期诊断和适当的手术治疗对于取得良好的效果是非常重要的.     

Intradural herniation of a lumbar intervertebral disc

Intradural disc herniation of an intervertebral disc is a rare occurrence. The clinical presentation varies in severity and a high level of suspicion is necessary to determine the diagnosis. This is a case report of an intradural disc herniation in a young male. A review of the literature identifying the pathophysiologic mechanisms of intradural disc herniation, diagnostic imaging techniques, and treatment is presented.     

Intradural lumbar disc herniation: report of two cases

Intradural lumbar disc herniation (ILDH) is a rare pathology. The pathogenesis of ILDH is not known with certainty. Adhesions between the ventral wall of the dura and the posterior longitudinal ligament (PLL) could act as a preconditioning factor. Diagnosis of ILDH is difficult and seldom suspected preoperatively. Prompt surgery is necessary because the neurologic prognosis appears to be closely linked to preoperative duration of neurologic symptoms. Despite preoperatively significant neurological deficits, the prognosis following surgery is good. We report on two new cases of ILDH of high lumbar locations L1–2 and L2–3 with difficult differential diagnoses, and the possible pathogenic factors are discussed. Received: 25 June 1998 / Accepted: 15 April 1999     

Intraradicular lumbar disc herniation: report of two cases and review of the literature

Intraradicular lumbar disc herniation is very rare. The exact mechanism of the dural tear by a herniated disc is not known. Diagnosis of intraradicular lumbar disc herniation is difficult, so that it is rarely suspected preoperatively. This pathological entity may be a factor in the failure of lumbar disc surgery. We present the seventeenth and eighteenth cases of intraradicular lumbar disc herniation. We emphasise its importance and review the literature on intraradicular disc herniation.     

Intradural disc herniations in the cervical, thoracic, and lumbar spine: report of three cases and review of the literature

The clinical, neuroradiological, and surgical management of three cases of intradural disc herniations--one each in the cervical, thoracic, and lumbar regions--are presented. Intradural disc herniations comprise only 0.27% of all herniated discs. Three percent occur in the cervical, 5% in the thoracic, and 92% in the lumbar spinal canal. Those with cervical or thoracic lesions frequently exhibit profound myelopathy, whereas those with lumbar lesions demonstrate radicular or cauda equina syndromes. Although varying combinations of the MRI, non-contrast CT, myelogram, and myelo-CT scans may at times fail to accurately establish the diagnosis of an intradural disc herniation prior to surgery, the index of suspicion raised by the lack of clinical correlation with surgical findings justifies an intradural exploration.     

Thoracic disc herniation. Analysis of 14 cases and review of the literature

Fourteen cases of thoracic intervertebral disc prolapse are reported and analysed. Eleven were women, 3 men, and the peak incidence was in the 5th decade. No trauma was reported in our cases. The T8/9 interspace was the most frequently involved. A sensory level was noticed in 6 cases and in four a clear cut sensory level at T10 was observed. Results of surgical treatment show that using microsurgical techniques costotransversectomy and its modifications are equally effective; laminectomy is contraindicated.     

腰椎间盘镜下治疗腰椎间盘突出症(附106例报告)

目的探讨后路经椎板间隙入路显微内镜下治疗腰椎间盘突出症的效果. 方法腰椎间盘镜下治疗腰椎间盘突出症106例. 结果 101例病例获得随访,疗效优92例(91.1%),良6例(5.9%),可3例(3.0%),优良率 97.0 %.结论镜下手术对脊柱稳定结构损伤小,术后恢复快,疗效可靠,适合于绝大部分单侧性腰椎间盘突出症患者.     

Iliac arteriovenous fistula as a complication of lumbar disc surgery. Report of two cases and review of literature

Vascular lesions following surgery of the lumbar disc are very infrequent, and exceptionally an arteriovenous fistula can developed. An important proportion of the reported cases were previously diagnosed as deep venous thrombosis, because this kind of pathology was not suspected. Postsurgical arteriovenous fistula produces severe haemodynamic disturbances, and congestive heart failure will develop if they are left to their natural course without intervention. Arteriovenous fistula should be suspected in the post-operative period of the lumbar disc surgery if congestive heart failure appears, accompanied by swelling of one or both lower limbs. Early surgery is the treatment of choice in order to prevent the congestive heart failure, and to preserve the normal function of the lower extremities. The technical choice seems to be the closure of the orifice of the fistula through the arterial lumen, together with appropriate arterial reconstruction.     

Alkaptonuria with lumbar disc herniation: a report of two cases

STUDY DESIGN: Two cases of lumbar disc herniation with alkaptonuria are presented. OBJECTIVES: To present a probable clinical course of lumbar disc herniation with alkaptonuria, a rare metabolic disease. SUMMARY OF BACKGROUND DATA: Although lumbar disc disease is a common clinical occurrence in alkaptonuria, lumbar disc surgery is needed rarely in this disease. A patient with alkaptonuria without ochronotic signs is also rarely seen. METHODS: The cause, clinical presentation, diagnostic techniques and treatment of alkaptonuria with lumbar disc disease are reviewed. RESULTS: The symptoms of the patients disappeared after surgery, and there were no symptoms on follow-up. CONCLUSION: Alkaptonuria frequently occurs in association with lumbar disc disease. In patients with no other signs of alkaptonuria or ochronosis, early detection of the disease is important to treat involvement of other systems (e.g., cardiovascular and urinary).     

Intradural lumbar disc herniations: the role of MRI in preoperative diagnosis and review of the literature

The goal of this article is to report our experience on intradural lumbar disc herniation, consider the causes of this pathology, and analyze it from clinical, diagnostic, and therapeutic perspectives with a particular emphasis on the role of MRI in preoperative diagnosis. We analyzed nine patients treated surgically for intradural lumbar disc hernia. All of them underwent surgery, and hemilaminectomy was performed. In six cases, the diagnosis of intradural herniation was definitive and, in the three remaining, it was confirmed at surgery. In five cases, CT (with no contrast medium) of the lumbar area revealed disc herniation, but none could it confirm its intradural location. Myelography was performed in two cases but also could not prove intradural extrusion. Magnetic resonance imaging study was used in four cases. In five, the postoperative outcome has been excellent. Patients 6 and 9 recovered anal function postoperatively; patient 6 suffered from occasional and mild micturition urgency. The three patients previously operated (1, 2, 7) showed good outcome. Presently, we believe that radiologic diagnosis of intradural herniation is possible in carefully selected patients, thanks to MRI with gadolinium.Commentaries on this paper are available at and     

Symptomatic gas-containing disc herniation. Report of four cases

Intradiscal gas collection, causing the radiographic vacuum phenomenon, is a common finding on radiographic studies of the lumbar spine. Four cases of radiographically documented and surgically confirmed cases of herniated discs containing gas are presented. All four patients presented with radicular symptoms secondary to the gas-containing herniations. Minimal nuclear material was found at surgery; however, all patients experienced relief after the operation.     

腰椎间盘突出并马尾神经综合征42例报告

目的 :对腰椎间盘突出并马尾神经综合征的治疗进行分析。方法 :对 42例病人进行回顾性研究。结果 :急性和亚急性发病的症状重 ,完全性损害恢复差 ,及时诊断及手术是提高疗效的关键。结论 :腰椎间盘突出并马尾神经综合征临床上并非少见 ,应注意对马鞍区及括约肌功能的检查 ,一旦诊断 ,应尽早手术     

Anterior discectomy and interbody fusion for lumbar disc herniation. A review of 350 cases

Based on the follow-up evaluation of 350 patients in whom lumbar disc herniation was treated by anterior discectomy and interbody fusion from 1955 to 1982, 94.3% of the patients obtained bony union and justified the principle of interbody stabilization of the spine. The normalization of the myelographic pattern observed after surgery indicates that sufficient nerve decompression can be obtained by this procedure. The good clinical results may be attributed to the restoration of disc height and to the correction of spinal alignment. The good results observed in long-term follow-up evaluation of 223 patients and the fact that most of the patients resumed their former work after surgery provide further testimony of the value of interbody fusion. The procedure is indicated in young adults, physical laborers with low back pain and sciatica, and patients with spinal instability.     

Ureteric obstruction secondary to endometriosis. Report of three cases with a review of the literature

Three cases of endometriosis are presented. In one patient bilateral obstruction was noted; in a second patient bilaterally enlarged kidneys with unilateral obstruction were found and in the third patient only unilateral obstruction was defined. Intrinsic ureteric obstruction and bilateral obstruction, both rare findings, are described in this report. The diagnosis, evaluation and management of these patients are discussed.