Ko Y, Kakiuchi M
Department of Orthopaedic Surgery, Osaka Police Hospital, Japan.
J Orthop Sci. 2001;6(1):88-91. doi: 10.1007/s007760170030.
We report a patient with nonoperatively treated acute cauda equina compression arising from an epidural clot that developed after decompressive surgery for lumbar canal stenosis. A 43-year-old woman underwent lumbar laminotomy, and was symptom-free for 3 hours; but this was followed by paresis. Postoperative myelography showed obstruction of the contrast column at the level of the laminotomy; this was relieved by hyperflexion of the lumbar spine. With sustained hyperflexion of the lumbar spine, all neurologic deficits were completely resolved within 5 days. Lumbar lordosis may be present when a patient lies in the supine position on a flat bed with the hips and knees extended; this may exacerbate dural constriction caused by an epidural clot following posterior lumbar spinal surgery.
我们报告了一名非手术治疗的急性马尾神经受压患者，其病因是腰椎管狭窄减压手术后形成的硬膜外血肿。一名43岁女性接受了腰椎椎板切除术，术后3小时无症状，但随后出现了轻瘫。术后脊髓造影显示在椎板切除水平造影剂柱受阻；腰椎过度前屈可缓解此情况。随着腰椎持续过度前屈，所有神经功能缺损在5天内完全恢复。当患者仰卧于平床上且髋部和膝部伸直时，可能会出现腰椎前凸；这可能会加重腰椎后路手术后硬膜外血肿引起的硬脊膜狭窄。
