Niu C C, Chen W J, Chen L H, Shih C H
Department of Orthopaedics, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan.
Arch Orthop Trauma Surg. 2000;120(10):594-7. doi: 10.1007/s004020000135.
A 63-year-old man with end-stage renal disease (ESRD) who had been undergoing hemodialysis for 18 years suffered persistent neck pain, progressive quadriparesis, and a deteriorating ataxic gait during the 6 months before admission. A sudden onset of aggravating quadriparesis and an inability to ambulate occurred during his trip to Sydney, Australia, 1 week before this admission. Vertebral tuberculosis osteomyelitis of the C5/6 segment was considered and treated in a hospital there. Findings from cervical magnetic resonance imaging (MRI; low signal intensity on both T1- and T2-weighted images) were diagnostic of destructive spondyloarthropathy (DSA) and distinguishable from spinal osteomyelitis preoperatively. Amyloid masses, mainly composed of B-2 microglobulin, filled in disc and paradiscal ligaments, with adjacent end-plate destruction by cytokine-mediated reactive inflammation, and appeared to be mostly related to the pathogenesis of DSA. The cervical spine, especially C5/6, is the most common site of DSA. Spinal instability and neurologic compression cause the clinical symptoms and signs. Adequate decompression and successful cervical fusion ensure the best therapeutic results.
一名患有终末期肾病（ESRD）且已接受血液透析18年的63岁男性，在入院前6个月出现持续性颈部疼痛、进行性四肢瘫以及共济失调步态恶化。入院前1周，他在前往澳大利亚悉尼途中突然出现四肢瘫加重且无法行走的情况。当地一家医院考虑并治疗了C5/6节段的椎体结核性骨髓炎。颈椎磁共振成像（MRI；T1加权像和T2加权像上均为低信号强度）结果诊断为破坏性脊椎关节病（DSA），术前可与脊髓骨髓炎相鉴别。淀粉样物质团块主要由β2微球蛋白组成，填充于椎间盘和椎间盘旁韧带，细胞因子介导的反应性炎症导致相邻终板破坏，似乎与DSA的发病机制密切相关。颈椎，尤其是C5/6，是DSA最常见的部位。脊柱不稳定和神经受压导致临床症状和体征。充分减压和成功的颈椎融合术可确保最佳治疗效果。
