Kreichati Gaby E, Kassab Farid N, Kharrat Khalil E
Orthopaedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon.
Eur Spine J. 2006 Jun;15(6):1015-8. doi: 10.1007/s00586-005-0947-x. Epub 2006 Apr 14.
To report a case of Cauda Equina syndrome with the completion of the paralysis after the reduction of a L4L5 dislocation due to a herniated disc. Although several articles have described a post-traumatic disc herniation in the cervical spinal canal, this is not well known in the lumbar region. A 30-year-old man was admitted to the emergency room with blunt trauma to the chest and abdomen with multiple contusions plus a dislocation of L4-L5 with an incomplete neurological injury. After an emergency open reduction and instrumentation of the dislocation, the patient developed a complete cauda equina syndrome that has resulted from an additional compression of the dural sac by a herniated disc. In a dislocation of the lumbar spine, MRI study is mandatory to check the state of the spinal canal prior to surgical reduction. A posterior approach is sufficient for reduction of the vertebral displacement, however an intra-canal exploration for bony or disc material should be systematically done.
报告一例因椎间盘突出导致L4-L5脱位复位后出现马尾综合征且瘫痪加重的病例。尽管已有多篇文章描述了颈椎管内创伤后椎间盘突出,但腰椎区域的此类情况尚鲜为人知。一名30岁男性因胸腹部钝器伤、多处挫伤以及L4-L5脱位伴不完全神经损伤被送入急诊室。脱位进行急诊切开复位及内固定术后,患者出现了完全性马尾综合征,这是由突出的椎间盘对硬脊膜囊的额外压迫所致。对于腰椎脱位,在手术复位前必须进行MRI检查以评估椎管情况。后路手术足以复位椎体移位,但应系统地进行椎管内骨块或椎间盘组织探查。