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Thoracic disc herniation mimicking acute lumbar disc disease 总被引:4,自引:0,他引:4
STUDY DESIGN: Case report of a 49-year-old woman with a lower thoracic disc herniation mimicking acute lumbosacral radiculopathy. OBJECTIVE: To describe an unusual case of thoracic disc herniation mimicking acute lumbar disc disease. SUMMARY OF BACKGROUND DATA: Symptomatic thoracic disc herniation is rare and its clinical manifestations differ widely from those of cervical and lumbar disc herniations. Midline back pain and signs of spinal cord compression progressing over months or years are the predominant clinical features. Acute and subacute thoracic disc herniation occurs in less than 10% of patients, and isolated root pain is unusual. METHODS: A 49-year-old woman had acute low back pain radiation into the left buttock and the lateral aspect of the left leg and left foot. Magnetic resonance imaging study showed a bulging disc and posterior osteophytes at T11-T12. RESULTS: Surgical removal of the herniated disc and osteophytes rapidly relieved her symptoms and neurologic deficits. A follow-up neurologic examination 3 years later showed normal motor and sensory functions, although low back soreness was noted occasionally. CONCLUSION: A case of thoracic disc herniation mimicking an acute lumbosacral radiculopathy is presented. Compression of the lumbosacral spinal nerve roots at the lower thoracic level after exit from the lumbar enlargement may be the mechanism for this unusual presentation. 相似文献
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A M Hidalgo-Ovejero 《Spine》1999,24(19):2066-2067
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目的分析麦肯基疗法联合骨盆倾斜腰椎牵引治疗腰椎间盘突出症的临床疗效。方法选取符合入选条件的腰椎间盘突出症患者80例,采用随机双盲对照试验(疗效评估者与患者对治疗不知情),将患者随机分为试验组(40例)和对照组(40例)。试验组患者接受麦肯基疗法联合骨盆倾斜腰椎牵引治疗,而治疗组仅采取单纯麦肯基疗法治疗。分别评估治疗前、1个疗程和3个疗程后患者的中医病证诊断疗效和视觉模拟评分(VAS)。结果 (1)1个疗程后,试验组的治疗有效率为60%,而对照组为55%,差异无统计学意义(P0.05);而3个疗程后,试验组的治疗有效率(82.5%)要远高于对照组(62.5%),且差异有统计学意义(P0.05)。(2)1和3个疗程后,试验组和对照组患者VAS评分相对治疗前,均有明显改善,且试验组的改善程度均明显优于对照组。结论麦肯基疗法联合骨盆倾斜腰椎牵引在腰椎间盘突出症治疗后期能够更有效地改善腰椎间盘突出症患者的症状和功能,值得临床推广。 相似文献
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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. 相似文献
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腰椎间盘突出与有无临床症状的影像对照研究 总被引:1,自引:1,他引:1
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。 相似文献
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《中国矫形外科杂志》2015,(15):1364-1367
[目的]探讨休门氏病(Scheuermann病)与腰椎间盘突出症的关系以及对该病的预测价值。[方法]回顾性分析本院352例因腰痛住院的患者,统计其中腰椎间盘突出症以及休门氏病患者的数量,对数据行Logistic回归分析,分析休门氏病与腰椎间盘突出症的关系。[结果]其中诊断为腰椎间盘突出症的患者219例,腰椎间盘突出症合并典型休门氏病的患者4例,合并非典型休门氏病的24例,两者都有的1例,无腰椎间盘突出症合并休门氏病的有1例,Logistic回归分析提示,非典型休门氏病的患者合并腰椎间盘突出症的危险性是没有非典型休门氏病患者的16.674倍(P0.05)。休门氏病的患者合并腰椎间盘突出症的危险性是没有休门氏病患者的1.439倍(P0.05)。[结论]休门氏病与腰椎间盘突出症有着相关性,尤其是非典型休门氏病对腰椎间盘突出症的患者有着高度预测价值。 相似文献
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Pradeep Suri David J. Hunter Cristin Jouve Carol Hartigan Janet Limke Enrique Pena Bryan Swaim Ling Li James Rainville 《The spine journal》2010,10(5):388-395
Background contextNo prior study has investigated the frequency of patient-identified inciting events in lumbar disc herniation (LDH) or their clinical significance.PurposeTo examine the clinical frequency of patient-identified inciting events in LDH, and to identify associations between the presence of inciting events and the severity of the clinical presentation.Study design/settingCross-sectional analysis of data from a cohort study with prospective recruitment, with retrospective data collection on inciting events. The setting was a hospital-based specialty spine clinic.Patient sampleOne hundred fifty-four adults with lumbosacral radicular pain and LDH confirmed by magnetic resonance imaging.Outcome measuresSelf-report measures of disability measured by the Oswestry Disability Index (ODI), the visual analog scale (VAS) for leg pain, and the VAS for back pain.MethodsDependent variables included the presence of a patient-identified inciting event, which were categorized as spontaneous onset, nonlifting physical activity, heavy lifting (>35 lbs), light lifting (<35 lbs), nonexertional occurrence, or physical trauma. We examined the association of an inciting event, or a lifting-related event, with each outcome, first using univariate analyses, and second using multivariate modeling, accounting for important adjustment variables.ResultsSixty-two percent of LDH did not have a specific patient-identified event associated with onset of symptoms. Nonlifting activities were the most common inciting event, comprising 26% of all LDH. Heavy lifting (6.5%), light lifting (2%), nonexertional occurrences (2%), and physical trauma (1.3%) accounted for relatively small proportions of all LDH. Patient-identified inciting events were not significantly associated with a more severe clinical presentation in crude analyses. Spontaneous LDH was significantly associated with higher baseline ODI scores in multivariate analysis, although the magnitude of this effect was small. There were no significant associations (p≤.05) between the presence of a lifting-associated event and the outcomes of ODI, VAS leg pain, or VAS back pain.ConclusionsThe majority of LDH occurred without specific inciting events. A history of an inciting event was not significantly associated with a more severe clinical presentation. There was no significant association between the occurrence of a lifting-related event and the severity of the clinical presentation. This information may be useful in the counseling of patients recovering from acute LDH. 相似文献
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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. 相似文献