腰椎间盘囊肿伴突出2例报告

<正>发生于椎间盘的囊肿是一种少见的脊柱疾病,2001年日本学者Chiba等[1]将其命名为椎间盘囊肿(discal cyst)。目前国内外报道案例不多,多以个案方式报道,且均为腰椎间盘囊肿。由于本病发病率低,临床医师认识不足,容易误诊。我们收治2例腰椎间盘囊肿伴突出的患者,报告如下。病例1男,27岁,因"腰痛6个月伴左下肢放射痛3     

Lumbar discal cyst with spontaneous regression and subsequent occurrence of lumbar disc herniation

A 39-year-old man presented with an extremely rare discal cyst at the L3-4 level manifesting as a left L4 radiculopathy. Two months after onset, he suffered right L4 radiculopathy with new lumbar disc protrusion. Five months after medical treatment, the patient's symptoms improved, and the discal cyst showed complete regression on magnetic resonance imaging. Most cases of discal cyst are surgically treated, with only two previous cases of spontaneous regression. The present case suggests clinical and radiological recovery of symptomatic lumbar discal cyst can be obtained by only conservative therapy.     

椎管内肿瘤误诊为腰椎间盘突出症原因探讨

本文分析误诊为腰椎间盘突出症的２４例椎管内肿瘤，其中８例以“椎间盘突出症”而施行手术，文内就其各种误诊原因进行讨论。     

Osteolytic lumbar discal cyst: case report

A 25-year-old man presented with left lumboischialgia refractory to medical treatment. Neurological examination revealed L5 and S1 radiculopathy which rapidly worsened over a short period. Magnetic resonance imaging demonstrated disk bulging with a discal cyst at the L4-5 intervertebral space and disk herniation at the L5-S1 intervertebral space. Computed tomography showed osteolytic change of the L5 vertebral body adjacent to the cyst. Resection of the cyst and removal of the herniated disk were performed following fenestration of the L4-5 and L5-S1 interlaminar spaces. Bloody serous fluid followed by clear serous fluid was recognized during the aspiration and partial resection of the cyst at the L4-5 level. Histological examination demonstrated a cyst wall consisting of fibrous connective tissue without a single-layer lining of cells, and fibrin deposits. The patient's symptoms disappeared immediately after the operation. This osteolytic lumbar discal cyst possibly occurred subsequent to hemorrhage from the epidural venous plexus following intervertebral disk injury, hematoma encapsulation by connective fibrous tissue, and cyst wall formation in reaction to the disk injury and hemorrhage. The cyst may have enlarged due to the inflow of the serous fluid from the water-containing degenerated disk.     

夹脊推拿法治疗腰椎间盘突出症

腰椎间盘突出症是临床上引起腰腿痛的主要原因之一,其治疗方法很多,主要可分为手术治疗和非手术治疗两种.而非手术治疗中手法是主要治疗方法.我们自1998年至今,在传统手法的基础上自创夹脊推拿法治疗本病293例,临床疗效显著,报告如下.……     

Immunohistological study of intervertebral disc herniation of lumbar spine

In order to observe histological changes in the extruded and sequestrated intervertebral disc, we conducted pathological and immunological examinations of herniated disc materials taken at the time of discectomy. There were 49 disc materials (from 38 men and 10 women [aged 19 to 78 years; average, 36.6 years]). The herniation was classified into four types, based on the intraoperative observations: protrusion (P), subligamentous extrusion (SE), transligamentous extrusion (TE), and sequestration (S). There were 19 P type discs, 3 SE type, 10 TE type, and 17 S type. The surgical specimens were stained with hematoxylin-eosin, as well as immunohistological staining with the labelled streptavidin biotin method, using human T-cell , human B-cell, and human macrophage antibodies. Inflammatory-cell infiltration was observed at the border of the disc. These findings were present in 19 discs (70%) of the 27 discs of TE and S types (10 TE and 17 S types), but were not seen in the 22 discs of P and SE types (19 P and 3 SE types). Immunohistological staining of the area with inflammatory-cell infiltration revealed the presence of T cells and macrophages, which suggested that this cell infiltration originated from T cells and macrophages, and that the spontaneous resorption of the disc may have resulted from the phagocytic activities of these cells. Received for publication on June 1, 1998; accepted on Nov. 8, 1999     

Case report of lumbar discal cyst

The authors describe a rare case of lumbar discal cyst which produced manifestations similar o lumbar disc herniation. A 33-year-old man, who had had a crick in the back 3 months previously, suffered from severe low back and right lower-extremity pain. The neurological examination showed the L5 radiculopathy through the positive straight leg-raising test, no motor weakness nor sensory disturbance with normal reflexes. Magnetic resonance imaging demonstrated an oval shaped extradural lesion with a low signal intensity on T1-weighted images and a high signal intensity on T2-weighted images. Additionally, the surrounding rim of the cyst was enhanced with the addition of Gd-DTPA. As we diagnosed a lumbar discal cyst with severe symptoms, the patient received emergent surgery. The symptom disappeared immediately after surgery. This case implies that early surgery for discal cyst may be an effective means to obtain release from symptoms.     

Radiologic case study. Intraspinal lumbar synovial cyst

In conclusion, intraspinal lumbar synovial cysts are uncommon causes of sciatic pain. Intraspinal synovial cysts are associated with degenerative arthritis of the lumbar spine. The radiographic findings on myelography are non-specific, but CT and MRI are helpful in establishing the diagnosis and in differentiating synovial cysts from other extradural lesions.     

Cytokines and growth factors in the protruded intervertebral disc of the lumbar spine

Nerve root irritation induced by factors produced by the intervertebral disc may play a crucial role in the pathophysiology of sciatic pain production. In this study we used immunohistochemistry to investigate the presence of transforming growth factor-beta1 (TGF-beta1), insulin-like growth factor-1 (IGF-1), interleukin-6 (IL-6), IL-6-receptor (IL-6R) and fibronectin in lumbar disc bioptic specimens from 30 patients with disc herniation (protrusion type). Chondrocytes of herniated discs stained positive for TGF-beta1, IGF-1, IL-6 and fibronectin. We demonstrated for the first time the presence of IL-6-R in the chondrocytes of herniated tissue. Specimens from autoptic healthy tissue were used as controls. In these sections no immunoreaction for TGF-beta1, IL-6, or IL-6R was found, while they expressed IGF-1 and fibronectin, but in lower quantities than herniated discs. These results demonstrated the production of factors such as TGF-beta1, IGF-1, IL-6, IL-6R and fibronectin at the site of lumbar disc herniation.     

腰椎间盘突出与有无临床症状的影像对照研究

目的：探讨应用区域定位评分法研究腰椎间盘突出（膨出、突出、脱出）有临床症状与无临床症状的相关性及原因分析。方法：将符合要求的CT病理分型为膨出、突出、脱出的体检或住院或门诊患者120例,按有临床症状与无临床症状分为2组,每组按CT病理分型分3组,年龄20-59岁,平均38．5岁,有临床症状与无临床症状两组间在性别、年龄、病程及椎间盘分布节段差异均无统计学意义;应用区域定位评分法对各组评分;用游标卡尺分别测量矢状径指数（SI）、盘黄韧带前间隙、侧隐窝上口宽度、硬膜囊前后径。CT值由X线断层扫描测定,分别测量3次,取平均值。结果：④腰椎间盘突出有临床症状与无临床症状两组在SI、CT值、CT评分、硬膜囊前后径之间差异无统计学意义（P〉0．05）;在侧隐窝上口宽度、盘黄韧带前间隙之间差异有统计学意义（P〈0．05）。②腰椎间盘突出有临床症状与无临床症状两组突出类型比较,差异有统计学意义（P〈0．05）;腰椎间盘脱出有临床症状与无临床症状两组突出节段比较,差异有统计学意义（P〈0．05）。结论：①腰椎间盘突出大小、部位、类型不一定与临床症状存在必然关系,腰椎间盘突出症与压迫程度无正比关系;②椎管内突出髓核是否导致相应的临床症状存在着诸多或必然因素,可能与椎间盘突出物可代偿的椎管储备容量、受累神经根对机械压迫的逃逸避让与弹性延长功能,以及受累神经根低氧消耗与抗缺血性损伤代偿作用等因素有关。     

Reoperation after lumbar intervertebral disc surgery.

This retrospective study includes 53 patients who underwent reoperation after failure of lumbar disc surgery to relieve pain. All patients had leg pain before reoperation, which was successful in 28% of cases. Most clinical features, such as persistence or mode of recurrence of pain, radicular quality of pain, positive straight-leg raising, and myelographic root sleeve defects, were not helpful in predicting successful and unsuccessful reoperations. However, a significantly larger percentage of women than men had successful reoperations. Patients who had past or pending compensation claims, who had sensory loss involving more than one dermatome, or who failed to have myelographic dural sac indentations resembling those caused by a herniated disc did poorly with reoperation. A very convincing myelographic defect appears to be needed to justify reoperation at a previously unoperated location. Excision of scar alone or dorsal rhizotomy was of no avail in these cases.     

单侧双通道脊柱内镜下手术治疗腰椎间盘囊肿的疗效观察

腰椎间盘囊肿是一种位于椎管内、硬膜外,与椎间盘相连的囊肿。是一种极其罕见的脊柱病变,它是造成腰痛的一个罕见原因。囊肿可压迫神经根,引起严重的神经根性疼痛或神经系统症状,其临床表现与腰椎间盘突出症临床表现类似,常难以鉴别。若对囊肿切除不彻底可增加复发的风险。单侧双通道内镜（unilateral biportal endoscopic,UBE）下手术可获得清晰的手术图像,术中可进行细致的操作,有助于椎间盘囊肿的诊断和切除。国内外现有文献多为临床个案报道,系统性研究较少。故本研究的主要目的是进一步评估UBE技术对椎间盘囊肿的治疗效果,并对文献中报道的病例进行系统回顾。     

Butterfly vertebra with lumbar intervertebral disc herniation

A butterfly vertebra is a rare congenital anomaly that is usually asymptomatic. The authors, however, describe a novel case involving a butterfly vertebra overlapping with disc herniation that presented as radiculopathy. A butterfly vertebra is characterized by a symmetrical fusion defect resulting in a sagittal cleft vertebra. Only a few cases of butterfly vertebrae have been reported as incidental findings. This spinal anomaly may be associated with other congenital conditions such as Pfeiffer, Crouzon, Jarcho-Levin, and Alagille syndromes. Moreover, there is no previous report of a case associated with symptomatic disc herniation from the sagittal cleft. The authors excised the herniated disc fragment. They performed intraoperative discography after exposure of the corresponding intervertebral space via a conventional interlaminar approach. Histological examination of a tissue specimen showed scattered chondrocytes in the myxohyaline stroma, which indicated the nucleus pulposus.     

人工腰椎间盘置换术在腰椎间盘突出症治疗中的应用

目的 探讨人工椎间盘置换术治疗腰椎间盘突出症的方法。方法 应用德国LINK公司的人工腰椎间盘置换手术治疗6例腰椎间盘突出症患者,其中腰4.5椎间盘置换5例,腰5骰1椎间盘置换1例,全部病例均有神经根压迫症状,经MR或CT确诊。结果 6例患者术后经半年以上随诊,腰腿痛症状完全消失,术后4天下床活动,术后3个月检查置换椎间盘恢复活动。结论 人工腰椎间盘置换术适合55岁以下1～2个腰椎间盘病变的治疗,具有临床症状缓解迅速、彻底,能保持脊柱稳定和恢复腰椎间的活动,但应严格掌握手术适应证及手术的操作方法。     

MRI classification of lumbar herniated intervertebral disc.

A consecutive series of 28 patients with lumbar herniated intervertebral disc (HIVD) who exhibited positive magnetic resonance imaging (MRI) findings was analyzed and compared with operative findings to define the type of disc herniation. This prospective study showed that the overall accuracy of MRI in predicting the types of HIVD was 80.6%. Proton density image was the most helpful in differentiating protruded discs from extruded ones. Disruption of "posterior longitudinal ligament line," defined on T2-weighted sagittal image, was reliable in differentiating a transligamentous disc from subligamentous one. Sequestered disc could be more accurately diagnosed with Gadolinium-DTPA enhancement, which showed anterior rim enhancement of the sequestered portion on T1-weighted axial image.     

Neurogenic bladder dysfunction in lumbar intervertebral disc prolapse.

Lumbar disc prolapse with urinary dysfunction is an uncommon condition. The clinical, pathological and follow-up details of 30 patients are presented. Detrusor recovery is rare and most patients are left with an areflexic bladder. Female patients with lumbar disc prolapse and an areflexic detrusor who strain to empty their bladders are likely to develop genuine stress incontinence. This may be managed by the early institution of intermittent self-catheterisation, which may reduce the need for incontinence surgery.