Seçkin Hakan, Bavbek Murad, Dogan Suheyla, Keyik Bahri, Yigitkanli Kazim
Department of Neurosurgery, Ministry of Health, Diskapi Educational and Research Hospital, 06110 Turkey.
Surg Neurol. 2006 Oct;66(4):357-60; discussion 360. doi: 10.1016/j.surneu.2006.01.028.
There is a well-recognized association between chronic back pain and the existence of an AAA. In literature, there are few reported AAA cases that describe patients with extensive pressure erosion of the vertebral body.
The authors present the case of a 38-year-old woman with chronic low back pain for the last 2 years in whom an AAA was formed during the follow-up period. The patient presented with an episode of low back pain following hard work 2 years ago. MR imaging of the lumbar spine was reported as disc degeneration at the L4-5 and L5-S1 levels. She was given medical treatment and was doing well with occasional back pain for a year. One year later, she suffered another disabling pain attack, and MR imaging revealed an additional focal disc protrusion at the L4-5 level. She was again medically treated. In August 2004, she presented with severe low back pain, and this time, MR imaging showed edema and erosion at the anterior part of L3 vertebra body. MR imaging studies (2- and 3-dimensional) depicted AAA as the cause. She was operated on, and the aneurysm was resected with graft repair of the site. She was pain-free in the postoperative period.
The evaluation of a patient with chronic back pain needs a thorough clinical and radiological workup. Limited evaluation of the bony and nervous structures of the spinal canal radiologically is insufficient. Pre- and paravertebral structures as well as vertebral body should carefully be evaluated to diagnose other causes of pain.
慢性背痛与腹主动脉瘤（AAA）的存在之间存在一种广为人知的关联。在文献中，很少有报道描述椎体广泛受压侵蚀的AAA病例。
作者介绍了一名38岁女性的病例，该患者在过去两年中患有慢性下背痛，在随访期间形成了腹主动脉瘤。患者于2年前因劳累后出现一次下背痛发作。腰椎磁共振成像（MR成像）报告显示L4 - 5和L5 - S1水平椎间盘退变。她接受了药物治疗，一年来偶尔有背痛，情况良好。一年后，她又遭受了一次致残性疼痛发作，MR成像显示L4 - 5水平新增局灶性椎间盘突出。她再次接受了药物治疗。2004年8月，她出现严重下背痛，这次MR成像显示L3椎体前部水肿和侵蚀。MR成像研究（二维和三维）显示腹主动脉瘤是病因。她接受了手术，切除动脉瘤并对该部位进行了移植修复。术后她无痛。
对慢性背痛患者的评估需要全面的临床和影像学检查。对椎管内骨骼和神经结构进行有限的影像学评估是不够的。应仔细评估椎前和椎旁结构以及椎体，以诊断疼痛的其他原因。
