Bandai Hideki, Ohara Yukoh, Dei Fumi, Mitsuoka Hideyuki, Bando Kuniaki
Department of Neurosurgery, Fujisawa City Hospital.
No To Shinkei. 2006 Oct;58(10):893-7.
We report a case of idiopathic thoracic spinal cord herniation. A 63-year-old female came to our hospital complaining of a slowly progressive gait disturbance that began 5 years ago. She showed signs of a left dominant spastic paraparesis and sensory disturbance. Her left foot had already became a drop foot from 2 years ago. Magnetic resonance (MR) imaging and computed tomographic (CT) myelography demonstrated that the atrophic spinal cord had displaced to the ventral side with a dilated dorsal subarachnoid space at T2-3 level. Surgery was performed via T2-3 laminoplastic laminectomy. The ventral aspect of the spinal cord revealed a defect in the inner layer of the duplicated dura mater, into which the gliotic spinal cord herniated. The herniated spinal cord was repositioned and the dural defect was repaired using a GORE-TEX dura substitute. Postoperative course was uneventful. Although the patient showed marked improvement in the right lower limb, there was slight improvement in the left lower limb. The clinical symptoms of this disease are uncommon and progress slowly, and if left untreated will result in paraparesis. Therefore early diagnosis and operation is important to prevent the progression of symptoms and to achieve a satisfactory outcome.
我们报告一例特发性胸段脊髓疝。一名63岁女性因5年前开始出现的缓慢进展性步态障碍前来我院就诊。她表现出左侧为主的痉挛性截瘫和感觉障碍体征。她的左脚从2年前就已经变成了垂足。磁共振（MR）成像和计算机断层扫描（CT）脊髓造影显示，萎缩的脊髓在T2 - 3水平向腹侧移位，背侧蛛网膜下腔扩张。通过T2 - 3椎板成形术进行手术。脊髓腹侧显示硬脊膜双层内层有缺损，胶质化的脊髓疝入其中。将疝出的脊髓复位，使用戈尔特斯（GORE-TEX）硬脑膜替代物修复硬脑膜缺损。术后过程顺利。尽管患者右下肢有明显改善，但左下肢仅有轻微改善。这种疾病的临床症状不常见且进展缓慢，如果不治疗会导致截瘫。因此，早期诊断和手术对于防止症状进展和取得满意疗效很重要。
