原发性椎管内肿瘤的诊治分析

目的探讨原发性椎管内肿瘤的临床特点及手术方法。方法回顾性分析最近3年来我科收治的18例椎管内肿瘤的临床特点、诊断要点及手术疗效。结果本组病人均行手术治疗，16例患者肿瘤完整切除，2例大部分切除。术后均经病理证实为良性椎管内肿瘤，其中神经鞘瘤7例，神经纤维瘤6例，脊膜瘤5例。除1例术后出现不全瘫痪外，其余患者临床症状及神经功能均有恢复。结论椎管内肿瘤以良性居多，手术效果佳，MRI检查及显微外科技术的应用是提高治疗效果的关键。     

棘突椎板复合体揭盖式回植在治疗原发性腰椎管内良性肿瘤中的应用

原发性椎管内肿瘤一旦诊断明确,手术切除是唯一选择。传统的手术方式为后路全椎板切除肿瘤摘除术,手术暴露充分,但易导致术后脊柱不稳[1、2]、瘢痕粘连,并引起医源性椎管狭窄,影响远期疗效。我院从2005年1月～2010年1月采用棘突椎板复合体揭盖式掀起、肿瘤切除后棘突椎板复合体回植的方法治疗原发性腰椎管内肿瘤13例,效果满意,报告如下。     

椎管内肿瘤的诊治分析

原发性椎管内肿瘤,其中大多数为良性肿瘤,主要表现为进行性脊髓受压症状.早期手术治疗预后良好,但其症状多变,给早期诊断带来一定困难.我院于1992年-2004年8月,共收治椎管内肿瘤18例,现将其诊治体会报告如下:     

小儿原发性椎管内肿瘤(附77例分析)

目的：作者通过对77例小儿原发性椎管内肿瘤进行综合分析。旨在为临床医生提供详尽材料，以关注此病的诊断与治疗，方法：对77例原发性椎管内肿瘤的病理分型，发病率，发病部位进行了回顾性分析。特别是对MRI的影像特点进行了重点论述。结果：77例均行手术治疗，肿瘤全切76例，仅1例室管膜瘤行部分切除治疗，全部病例获得随访，术后症状消失或明显改善76例，脂肪瘤及脂肪纤维瘤占48%，皮样囊肿及畸胎瘤占22%，蛛网膜囊肿占15.6%。神经纤维瘤占4%，80%的病人肿瘤发生在腰骶部，所以常常合并脊髓栓系综合征，结论：（1）小儿原发性椎管内肿瘤以先天性的肿瘤为常见，而成人常见的神经鞘膜瘤和神经胶质瘤不多见。（2）MRI是椎管内肿瘤目前最精确的诊断方法，对肿瘤的治疗和预后价值极大，应广为利用。（3）一旦确诊应尽早手术治疗。     

原发性椎管内肿瘤的MRI诊断及鉴别诊断

本文通过对58例经手术病理或临床随访证实的原发性椎管内肿瘤,包括神经鞘瘤25例、脊膜瘤11例、髓内胶质瘤12例、蛛网膜囊肿5例、皮样囊肿2例、淋巴瘤2例、脂肪瘤1例。对各类肿瘤的MRI表现特征及鉴别诊断作了分析讨论,认为MRI对原发性椎管内肿瘤的诊断有重要价值     

椎管内肿瘤的诊断与手术治疗

目的 探讨椎管内肿瘤的诊断与手术治疗.方法 33例椎管内肿瘤经后路手术切除.结果 全切除29例,功能改善23例,加重4例,有效率为69.7%.结论 手术切除是治疗椎管内肿瘤的唯一方法,不同部位和不同性质的肿瘤要采取不同的手术方法.     

原发性椎管内脊膜瘤诊疗分析

目的探讨原发性椎管内脊膜瘤诊断与手术治疗方法。方法回顾性分析2005至2011年经显微外科技术切除病理证实的原发性椎管内脊膜瘤32例临床资料,全部病例均行椎板棘突复合体截取原位回植椎管成形术。结果术后随访3个月~5年,肿瘤无复发,脊髓损伤ASIA分级提高1~3级,无重建的椎板棘突复合体向椎管内塌陷、椎管后凸畸形、医源性椎管狭窄症。结论 MRI是椎管内脊膜瘤最佳的诊断方法;显微外科技术可提高肿瘤全切除率,减少手术并发症;椎板棘突复合体截取原位回植椎管成形术有利于脊柱稳定性的维持。     

椎管内肿瘤400例临床分析

作者自1976～1996年共收治椎管内肿瘤400例。本文对400例椎管内肿瘤主要临床表现、特异性检查临床符合率、手术效果及病理结果进行分析，阐明椎管内肿瘤的诊断、定位、定性方法，进一步指出椎管内肿瘤多为良性肿瘤，皆应手术治疗，以期达到不同程度的缓解。术后完全治愈及功能大部分恢复者合计达64．70％。     

显微手术治疗颈胸段原发性椎管内肿瘤

目的探讨应用显微手术方法治疗颈胸段原发性椎管内肿瘤的效果。方法36例颈、胸段椎管内肿瘤患者,均在显微镜下进行肿瘤切除手术,其中5例采用侧后方入路,31例采用后正中入路。结果肿瘤完全切除29例,大部分切除7例。随访31例,平均14.3（1-35）个月。症状消失19例,减轻9例,无改善3例,无加重及死亡病例。复发5例,再手术4例。结论采用显微手术治疗能最大限度减少肿瘤残留,同时保存脊髓及神经的功能。     

椎管内肿瘤21例手术治疗报告

目的:总结手术治疗肿瘤的经验。方法:回顾性总结了我院过去10年来对21例椎管内肿瘤的手术疗效结果。结果:本组21例椎管内肿瘤,其中椎管内硬膜外肿瘤4例,硬脊膜下髓外肿瘤15例,髓内肿瘤2例;颈段5例,胸段10例,腰段6例;术后病理分型脊膜瘤7例,神经鞘瘤9例,星形细胞瘤2例,转移瘤3例。21例中有11例行磁共振检查后再行显微外科手术切除肿瘤,其中10例为全切除,1例为次全切除,出院时症状均大大改善。结论:椎管内肿瘤以良性居多,手术治疗效果好。MRI检查及显微外科手术的应用是提高治疗效果的关键。     

Chondroblastoma of the lumbar spine with cauda equina syndrome

STUDY DESIGN: Case report. OBJECTIVE: To describe the clinical presentations, radiological features and clinical progress of a rare case of chondroblastoma of the lumbar spine. SETTING: Regional Hospital, Hong Kong, China. METHOD: A 54-year-old male patient presented with low back pain and left sciatica. X-ray and MRI revealed tumour infiltration of the fifth lumbar vertebrae and left paraspinal muscles, which was found to be a chondroblastoma by repeated open biopsies. The tumour was removed surgically by combined anterior and posterior approaches, followed by spinal fusion and instrumentation. RESULTS: The anterior tricortical bone graft was complicated with fracture and nonunion. Surgical re-exploration confirmed local recurrence of tumour macroscopically and histologically. The patient developed symptoms and signs of cauda equina syndrome gradually despite repeated surgery and irradiation. The patient eventually died of complications of local recurrence and neurological deficit at 3 years and 8 months after the first operation. CONCLUSION: This is the first case report of chondroblastoma of the lumbar spine. The clinical profile of this patient and the evidence from the literature review suggests that spinal chondroblastoma has a very aggressive behaviour with high recurrence and mortality rate.     

腰椎狭窄软性椎管的应力改变分析

目的 探讨腰椎软性椎管改变与椎管狭窄的关系。方法 在本研究52例中分为椎管狭窄组和对照组，2003年1月至2007年12月，推管狭窄组从因腰椎管狭窄病行后路椎板减压术的患者中取黄韧带标本对照组黄韧带标本共为10例，取自青年腰椎骨折行后路椎板减压术患者，后纵韧带标本共4例取自腰椎爆裂骨折前路椎体减压术患者。分别观察两组标本切片镜下的表现并加以分析。结果 在腰椎管狭窄病组，黄韧带及后纵韧带镜下表现为纤维肥大，基质内可见脂肪及小囊肿；对照组则表现为纤维细胞排列规则、无纤维化表现。结论 腰椎管软性椎管的应力改变及退行性变，是导致腰椎管狭窄的一个因素。     

Discal cysts of the lumbar spine: report of five cases and review of the literature

Discal cysts are rare causes of low back pain and radiculopathy. Only few reports in the literature describe these pathologies. In this article, the authors report five cases (3 males and 2 females) of lumbar discal cysts treated surgically by microdiscectomy. These patients were admitted with a history of back pain and/or sciatalgia. Magnetic resonance imaging of the lumbar spine of all patients revealed lumbar discal cysts, causing compression to the spinal dura and roots. All patients were treated by partial hemilaminectomy and microscopic cyst resection. Postoperatively, the complaints showed improvement, and the patients were discharged with no complications. The cases of lumbar discal cysts are described in the literature as individual case reports, therefore; the authors performed a wide systemic review of all these cases published in PubMed and MedLine, including the patients in the present report. The data of all patients were analyzed to obtain statistically based estimated information about the incidence, the epidemiology, the natural history and the optimum management of these lesions.     

Unrecognized durotomy after lumbar discectomy: a report of four cases associated with the use of ADCON-L

STUDY DESIGN: This report describes four cases of symptomatic cerebral spinal fluid leak after lumbar microdiscectomy where ADCON-L was used. OBJECTIVES: To report that ADCON-L may exacerbate cerebral spinal fluid leak from unrecognized, small dural tears after lumbar discectomy. SUMMARY OF BACKGROUND DATA: ADCON-L is a porcine-derived polyglycan that is used with increasing frequency in spinal surgery. It is advocated to reduce postoperative peridural fibrosis and adhesions. METHODS: Four cases of symptomatic cerebral spinal fluid leak after lumbar microdiscectomy were identified. Information on these patients was obtained by chart review. RESULTS: Three patients had small, inadvertent durotomies that were not appreciated at surgery even with the aid of a microscope. The dural violation in the fourth patient occurred at the previous epidural steroid injection site located on the contralateral side of the laminotomy. CONCLUSION: ADCON-L may inhibit dural healing and exacerbate cerebral spinal fluid leak from microscopic durotomies not recognized at the time of surgery.     

Intermittent parasympathetic symptoms in lumbar spinal stenosis

Symptoms related to autonomic nervous dysfunction are uncommon in spinal stenosis. Involvement of nerve roots S2-S5 has previously been reported only in a few cases. Of great interest is the occurrence of phenomena such as intermittent penile erections and fecal incontinence on walking in patients with compromise of the lower lumbar spinal canal. We report on two patients, one of whom presented because of fecal incontinence and the other with penile erections on walking. In both cases, these manifestations resolved after decompressive laminectomy. These patients are compared to six other patients, with parasympathetic disturbances due to lumbar spinal stenosis, described previously.     

Subtle clinical signs of a spinal cord ependymoma at the cervicothoracic level in an adult: a case report

A 33-year-old male presented to a chiropractic clinic complaining of chronic, recurrent low back pain. Subtle signs of muscle atrophy were noted in the left hand during the history taking. This muscle atrophy was reported as having a gradual onset spanning the past six months without any precipitating event. Cervical, thoracic and lumbar spinal radiographs were deemed unremarkable. Due to the progressive nature of the neurological deficit, the patient was referred for a neurological consultation. A magnetic resonance imaging (MRI) study was performed and revealed an expansive intramedullary lesion between C6 and T1 suggesting a differential diagnosis of spinal cord ependymoma or astrocytoma. The patient underwent surgical excision of the tumour. Pathological report confirmed a diagnosis of ependymoma. In the presence of subtle clinical signs, clinicians should keep a high index of suspicion for spinal cord tumours.     

小切口加脊柱花刀治疗髓核骨化性腰椎间盘突出症

为保留腰椎后部结构的完整性，防止术后腰椎不稳，采用小切口单侧小开窗加脊柱花刀治疗旁侧型髓核骨化性腰椎间盘突出症22例，单侧扩大开窗加脊柱花刀治疗中央型髓核骨化性腰椎间盘突出症10例。手术尽可能地保留了腰椎全部结构的完整性，可防止术后腰椎不稳和减少对硬膜和神经根的疤痕粘连。并就32例髓核骨化性腰椎间盘突出症患者CT图像中髓核骨化的形式和形态进行了讨论。     

Minimally invasive transmuscular approach for the treatment of benign intradural extramedullary spinal cord tumours: Technical note and results

BackgroundMinimally invasive surgery has expanded over the past two decades and was initially used for the treatment of lumbar disc herniation. Later, this approach was used to treat other spine pathologies, as well as to perform spinal fusion and extended spinal decompression. In this study, we report our experience regarding the use of a minimal surgical approach in the treatment of intradural extramedullary spinal cord tumours.MethodsBetween January 2008 and July 2013, 18 patients with an intradural extramedullary tumour were included in the study (13 thoracic, 4 lumbar and one cervical tumours). The mean age was 59 years. We operated on 11 meningiomas, 6 neurinomas and one ependymoma. All patients underwent minimally invasive surgery using a tubular retractor system to perform a hemilaminectomy in order to access the spinal canal. Fifteen patients had a neurological deficit and 7 suffered from radicular pain prior to surgery.ResultsGross completed resection was performed in all patients. Mean time of surgery was 95 min. Blood loss was less than 200cc. Fifteen patients out of 18 were able to get up the day after surgery. Mean hospital stay was 6 days. There were no complications.ConclusionA minimal surgical approach using a tubular retractor permits an effective resection of intradural extramedullary tumours. This procedure may be a useful tool to decrease the risk of secondary spine instability and postoperative kyphosis, and could also be used for spinal junctions and in fragile patients.     

Continuous neural monitoring in lumbar spine surgery: experience with 101 patients.

The first report about lumbar spinal surgery under epidural anesthesia has been published in 1958. The aim of this study was assess to epidural anesthesia as a regional operative anesthesia in lower lumbar spine surgery and to use the opportunity of verbal interaction with the patient who is able to move her/his lower extremities voluntarily during surgery. We called this simultaneous clinical assessment process as continuous neural monitoring. Established pathologies in the patients were as follows; lumbar herniated intervertebral disc disease (n = 95), lumbar spondylolisthesis (n = 4), lumbar lamina fracture (n = 1) and lumbar dumbbell Ewing's sarcoma (n = 1). Preoperative findings, operative findings, operative complications, postoperative complications and short-term results were assessed by the surgeon-anesthesiologist team. The patients, 99 out of 101, were followed-up for more than 15 months (mean 21.2 months). Fair and failure results were assessed in 7.0 % of the patients. Even though epidural anesthesia is almost equal to general anesthesia in terms of anesthetic complications, surgical complications and surgical results in uncomplicated lumbar spinal surgery cases, it has the advantage of being able to simultaneously evaluate motor results of surgical maneuvers and/or manipulations on the neural structures. This advantage, which is not available at the same accuracy with other neurophysiologic monitoring modalities, would be valuable in complex lumbar spine surgery cases.     

腰椎管成形术的设计与临床应用

采用作者设计的一种新型的腰椎管成形术，自１９８９年以来，共治疗严重型腰椎管狭窄症１３例。随访１～３年，优良率达１００％，术后未发生一例腰椎不稳，４例退变型腰椎滑脱者术后无一例滑脱加重。该手术通过椎管成型、扩大椎管、改良Ｈ形植骨及脊柱张力带钢丝固定，使椎管得到彻底减压，腰椎后部结构得到重建，从而达到防止术后腰椎不稳、硬膜及神经根疤痕粘连之目的。临床应用表明，该法较传统的椎板切除术疗效好。