颈椎间盘突出症合并腰椎间盘突出症的非手术治疗

目的：研究非手术治疗颈椎间盘同症合江腰椎间盘同症的疗效。方法：核计从１９９０．２至１９９８．２,住院患者中颈椎间估出症合交腰椎间盘突出症５５例,同期颈椎间突出症３５７例,腰椎间盘突出症５８９例,分别占１５．４１％和９．３４％,优良率为８０％。而且作者描述了该疾病的症状、体征、非手术治疗的方法,同时介绍了牵引、推拿的注意事项。结论：非手术治疗（包括干扰素治疗）颈椎间盘突出症合并腰椎间盘突出症是有效的     

Brown-Sequard syndrome revealing intradural thoracic disc herniation

Brown-Sequard syndrome (BSS) is a rare form of severe myelopathy characterised by a clinical picture reflecting hemisection of the spinal cord. This syndrome is mostly due to a penetrating injury to the spine but many other non-traumatic causes have been described. Intradural thoracic disc herniation (TDH) is one of the rare aetiologies of this syndrome. Despite progress in imaging techniques, diagnosis and treatment remain difficult. We retrospectively reviewed one of the largest reported series of six patients with BSS revealing intradural TDH between 2003 and 2007. There was a marked female predominance and the mean age was 44 years. Before surgery, half of the patients had a severe neurological deficit. The mean duration of symptoms until surgery was 8.5 months (range 0.5–24 months). Spine magnetic resonance imaging (MRI) or spine computer tomography scan showed calcified TDH between T5–T6 and T9–T10. The intradural location of the thoracic herniation was strongly suspected from the clinical data. All the patients underwent posterolateral transpedicular surgery with an operative microscope to open the dura mater. The intradural location of the herniation was overlooked in one case and the patient underwent a second procedure. The dura mater was carefully closed. Two patients’ condition worsened immediately after the surgery before slowly improving. All the other patients improved their neurological status immediately after the surgery and at 12 months follow-up. BSS with TDH on the spine MRI scan may be a warning symptom of the intradural location of the herniated disc. In such cases, spine surgeons are advised to use an operative magnification and to open the dura mater to avoid missing this potentially curable cause of severe myelopathy.     

囊内型腰椎间盘突出症的临床诊治

椎间盘突入硬膜囊内称之为囊内型椎间盘突出症(intradural dise herniation，IDDH)，其发病约占腰椎间盘突出症的0.04％～1.51％。由于发病率低，易误诊，因此临床报道较少。我院自1986年-2002年间，完成腰椎间盘突出症手术1862例，其中腰椎IDDH8例，约占0.43％。现将本组8例的临床诊治方法进行分析。     

囊内型腰椎间盘突出症的诊断和治疗

[目的]探讨囊内型腰椎间盘突出症的诊断和外科治疗.[方法]回顾性分析7例囊内型腰椎间盘突出症的临床特点、CT、MRI检查及手术情况.[结果]经1～4 a随访,本组完全恢复4例,部分恢复3例.[结论]MRI检查在诊断上具有特殊的临床意义,正确的诊断和及时的手术治疗是取得良好效果的关键.     

Cervical brucellosis mimicking cervical disc herniation

Brucellar spondylitis may be difficult to diagnose. Initial plain radiographs of the spine may show mild degenerative lesions. Although, magnetic resonance imaging of spine is mostly helpful to establish the disease, in some cases, it may lead to misdiagnosis. The aim of this report was to present a case of brucella infection involving the cervical spine that was falsely diagnosed and underwent to surgery for cervical disc herniation. Since the spinal form of brucellosis has no specific symptomatology, a patient has symptoms with mimicking the cervical hernia, with a history of disabling pain more severe than radicular pain, and especially who reside in countries where the disease is endemic, the brucella infection should be kept in mind in the differential diagnosis and specific diagnostic investigations such as brucella agglutination tests should be made before any treatment procedure.     

Spontaneous resorption in recurrent intradural lumbar disc herniation. Case report

The authors report a case of spontaneous resorption of intradural disc material in a patient with recurrent intradural lumbar disc herniation and review magnetic resonance (MR) imaging and histopathological findings. Intradural lumbar disc herniation is rare, and most patients with this condition require surgical intervention due to severe leg pain and vesicorectal disturbance. In the present case, however, the recurrent intradural herniated mass had completely disappeared by 9 months after onset. Histological examination of intradural herniated disc tissue demonstrated infiltrated macrophages and angiogenesis within the herniated tissue, and Gd-enhanced MR images showed rim enhancement not only at the initial presentation, but also at recurrence. The authors conclude that when rim enhancement is present on Gd-enhanced MR images, there is a possibility of spontaneous resorption even though the herniated mass may be located within the intradural space. Moreover, when radiculopathy is controllable and cauda equina syndrome is absent, conservative therapy can be selected.     

A pure fluid-filled intradural cyst associated with intradural disc herniation and possible pathogenesis: a case report

Background contextLumbar intradural disc herniation (IDH) is rare, and intradural cyst associated with IDH is quite rare. Only seven cases of an intradural cyst associated with lumbar disc herniation have been reported, and all were gas-filled cysts. We report the first case, to our knowledge, of a fluid-filled intradural cyst associated with IDH.PurposeTo report an extremely rare case of a fluid-filled intradural cyst associated with lumbar IDH and suggests the possible pathogenesis.Study designCase report.MethodsAn 82-year-old woman presented with right leg pain and motor weakness. Computed tomography and magnetic resonance imaging (MRI) scans showed calcified lumbar disc herniation and an intradural cystic mass at the L1–L2 level. An MRI, which was performed 2 years before admission, showed an IDH without a cyst at the same level.ResultsSurgical resection of the intradural cyst was performed. Intraoperative finding showed a fluid-filled intradural cyst with 1-cm diameter of displacing nerve rootlets. The cyst was connected with extradural cystic components through a ventral dural hole, but the tract was blocked by fibrous septum. Histopathologic examination showed a pseudocyst that consisted of degenerative cartilaginous and fibrous tissues, including degenerative disc materials. We concluded that the cyst was an intradural cyst transformed from the intradural disc fragment.ConclusionsThe current case is the first report to our knowlege of a fluid-filled intradural cyst associated with IDH. The possible mechanism may be focal degeneration and spontaneous absorption of the intradural disc with fluid production. Unlike the gas-filled intradural cysts, the cause of the pure fluid-filled cyst may be disconnection from the intervertebral vacuum because of a calcified disc and septation of the cyst.     

Cervical disc herniation causing localized ipsilateral popliteal pain

We report a patient with localized ipsilateral popliteal pain that we believe was caused by cervical disc herniation. A 52-year-old woman complained of an unusual severe aching pain in the right popliteal region. The pain increased gradually for 4 months despite the employment of conservative treatments. Eventually, the woman was unable even to stand immediately after waking because of the pain. However, physical examination of the right knee joint showed little abnormality. Although radiography of the knee joint showed slight osteoarthritic change, the pain remained unexplained. The patient also reported shoulder stiffness and slight numbness in the bilateral toes. Magnetic resonance imaging showed a large disc herniation on the right side of C3/4 and narrowing of the spinal canal at C4/5. Anterior cervical decompression and fusion surgery (C3–5) was performed to prevent impending myelopathy. After surgery the popliteal pain disappeared immediately and completely, suggesting that the cervical disc herniation had caused the pain. The pain has not recurred in almost 3 years after surgery. Received: April 26, 2001 / Accepted: August 14, 2001     

Conus medullaris syndrome due to an intradural disc herniation: A case report

A 70-year-old male patient developed acute paraplegia due to conus medullaris compression secondary to extrusion of D12-L1 disc. After negative epidural examination intraoperatively, a durotomy was performed and an intradural disc fragment was excised. Patient did not regain ambulatory status at two-year follow-up. Intraoperative finding of negative extradural compression, tense swollen dura and CSF leak from ventral dura should alert the surgeon for the possibility of intradural disc herniation. A routine preoperative MRI is misleading and a high index of suspicion helps to avoid a missed diagnosis.     

人工颈椎间盘置换治疗颈椎间盘突出症

[目的]探讨Bryan人工颈椎间盘假体置换治疗颈椎间盘突出症的临床效果。[方法]本组14例颈椎间盘突出症患者，男10例，女4例；年龄31～52岁，平均43岁。C3、4例，C4、5，2例，C5、68例，C4、61例，C3-61例。单节段置换12例，双节段置换2例，共置换16个椎间盘假体。Bryan假体由金属外壳和聚氨酯髓核组成，外壳有钛微孔喷涂层。术后摄颈椎动态X线片观察假体稳定性及活动度。[结果]术后随访最长28个月，平均10个月。全部患者神经功能均有明显改善，CSM40分法评分平均提高8．5分，有效率为100％，无假体松动和脱落，术后置换节段活动度平均为6．4。。[结论]人工颈椎间盘假体置换具有确切的稳定性和相应的活动度，是治疗颈椎间盘突出症的可选择方式之一。早期临床效果良好，远期效果有待于进一步观察。     

Giant intradural disk herniation]

The authors present a rare case of the total intradural sequester from a prolapsed lumbar disc at the L4 level. This kind of hernations comprise 0.3% of all disc hernations. Surgical treatment resulted in a good outcome.     

颈椎间盘突出症的MRI表现及意义

探讨了１１８例颈椎间盘突出症的ＭＲＩ表现及异临床意义。在ＭＲＩ上，本病可分为中央型和侧方型。前者颈椎间盘从其后方中央部位突出，压迫颈髓前方，受压颈椎弯曲、变扁及向后移位；后者可见椎间盘从后外侧呈块状或碎片状突出，压迫颈髓前外侧，神经根向后外侧移位或消失。本组结果表明，ＭＲＩ可直接显示颈椎间盘突出症的部位、类型及颈髓和神经根的受损程度，为颈椎盘间突出症的诊断、鉴别诊断、治疗方法选择和预后判断提供可靠的方法。     

Cervical disc herniation missed at operation: a case report

Disc herniations are less common in the cervical spine than in the lumbar spine. Nevertheless, chiropractors can anticipate seeing a small number of patients with this problem on an annual basis. When confronted with this problem, it is important to diagnose the level of the herniation. This report describes a case in which a cervical disc herniation was treated surgically at the wrong level. The patient subsequently presented for chiropractic treatment. He was pain-free upon completion of a short course of manipulation.     

颈椎全人工椎间盘置换术治疗颈椎间盘突出症1例报告

颈前路减压植骨融合固定术是治疗颈椎间盘突出症及颈椎病的常用手术方式，它可以同时进行脊髓及神经根减压和重建颈椎稳定性。但颈椎间隙融合后，邻近节段的应力集中，易导致相邻节段的椎间盘加速退变，部分病例需要再次手术。，为此我们应用颈椎全人工椎间盘假体治疗颈椎间盘突出症1例．取得了初步疗效，现报告如下。     

Microsurgical cordotomy in 20 patients with epi-/intradural fibrosis following operation for lumbar disc herniation

Summary Using an improved microsurgical technique, cordotomy was carried out by the cervicothoracic route in 20 patients with persistent radicular pain due to epi-/intradural fibrosis following operation for lumbar disc herniation. 65% of them had good long-term results with respect to radicular pain (follow-up period 6–132 months; mean 66 months). Permanent severe motor impairment was not observed. In patients with severe pain of benign organic origin microsurgical cordotomy can be considered as a last resort.     

Lumbosacral intradural tumours simulating disc disease

Summary Twelve patients with symptoms and signs simulating lumbar disc disease were found to have intradural tumours in the lumbosacral area. Of the nine patients with a neurofibroma, two had previously had a laminectomy for an erroneous diagnosis of disc herniation and one had three separate tumours which were excised in two successive operations. One of the three patients with an ependymoma had a coccygectomy before the correct diagnosis was made. Only one patient who had an ependymoma showed radiographic abnormalities suggesting a neoplastic lesion, but eight of the ten cases in which the cerebrospinal fluid was analysed had a protein content exceeding 50 mg per 100 ml. Myelography provided the correct diagnosis in all cases. Excision of the tumour resulted in full clinical recovery except for one patient with an ependymoma.

---

Résumé Chez douze malades présentant une symptomatologie évocatrice d'une hernie discale lombaire, on a découvert une tumeur intradurale. Des neuf patients porteurs d'un neurofibrome, deux avaient subi auparavant une laminectomie du fait d'une erreur de diagnostic avec une hernie discale et un avait trois tumeurs distinctes dont l'ablation nécessita deux interventions successives. Un des trois malades atteints d'épendymome avait subi une résection du coccyx avant que le diagnostic exact ait été posé. Un seul patient, porteur d'un épendymome, présentait des anomalies radiologiques évocatrices d'une lésion néoplasique, mais huit des dix sujets chez lesquels a été pratiqué l'examen du liquidecéphalo-rachidien avaient une albuminorachie supérieure à 50 mg pour 100 ml. La myélographie a permis un diagnostic correct dans tous les cas. L'éxérèse de la tumeur a toujours permis d'obtenir la guérison complète, sauf chez un malade porteur d'un épendymome.

     

Spinal cord stimulation in 112 patients with epi-/intradural fibrosis following operation for lumbar disc herniation

Summary A total of 112 patients with epi-/intradural fibrosis following operation for lumbar disc herniation were treated by spinal cord stimulation. Lumbosacral spinal fibrosis is seen particularly often after extensive and repeated operations. Radicular pain responds better to stimulation than back pain. A favourable long-term effect on radicular pain has been observed in 67% of patients treated by epidural implantation, the corresponding average follow-up period being 4 1/2 years. 40% of these patients needed less analgesics after the operation, while 25% of them showed an improved fitness for work. Among about 5,000 patients who underwent surgical treatment for lumbar disc herniation, an indication for spinal cord stimulation was found in 1,5%. By comparison, the frequency of the last resort procedure of microsurgical cordotomy was 0.3%. We no longer use other ablative methods like extirpation of spinal ganglia.