Hodges S D, Humphreys S C, Eck J C, Covington L A
Center for Sports Medicine and Orthopaedics, Foundation for Research, Chattanooga, Tenn 37404, USA.
J South Orthop Assoc. 1999 Fall;8(3):222-8.
We present the unique case of a patient with a sequestered disk fragment posterior to the thecal sac producing symptoms of spinal stenosis with neurogenic claudication. The majority of sequestered disk fragments migrate in either a cranial or caudal direction. In only a few cases have disk fragments been identified posterior to the thecal sac. Our patient had a sudden onset of bilateral groin and anterior thigh pain. Magnetic resonance imaging showed relatively severe stenosis at L4-5 with mild disk bulging. Intraoperatively, a large posteriorly placed encapsulated mass of soft tissue was found compressing the posterior portion of the thecal sac. Patients with acute onset of symptoms of spinal stenosis should have herniated disk included in their differential diagnosis, even in the absence of imaging confirmation.
我们报告了一例独特病例，患者的硬膜囊后方存在一个游离椎间盘碎片，引发了脊髓狭窄伴神经源性间歇性跛行的症状。大多数游离椎间盘碎片会向头侧或尾侧移动。仅有少数病例中，椎间盘碎片被发现位于硬膜囊后方。我们的患者突然出现双侧腹股沟和大腿前部疼痛。磁共振成像显示L4 - 5节段存在相对严重的狭窄，伴有轻度椎间盘膨出。术中发现一个位于后方的、较大的、有包膜的软组织肿块压迫着硬膜囊后部。即使在没有影像学证实的情况下，对于急性出现脊髓狭窄症状的患者，鉴别诊断时也应考虑椎间盘突出。
