Liu Sen-Yung, Lin Yueh-Min, Wei Ta-Sen, Lin Shan-Ju, Liu Chen-Chen, Chou Chii-Wen
Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan.
Kaohsiung J Med Sci. 2007 Sep;23(9):480-5. doi: 10.1016/S1607-551X(08)70057-3.
Herniation of the lumbar disc is a common cause of low back pain. Conservative management with physiotherapy, such as lumbar spine traction, is usually effective. Although a schwannoma of the lumbar spine is relatively uncommon, the clinical manifestations are similar to those of lumbar disc herniation, making the diagnosis difficult. This case report describes a 51-year-old male who had suffered from low back pain for 3 years and who was diagnosed with L2/L3 lumbar disc herniation. The low back pain was well-controlled by conservative treatment and the symptoms improved progressively. Two months prior to our evaluation, however, the symptoms worsened acutely, and were accompanied by the onset of symptoms of cauda equina syndrome. A small tumor at the site of the L2/L3 disc herniation, observed incidentally during magnetic resonance imaging, was responsible for the symptoms of spinal stenosis at the lumbar region. The patient underwent laminectomy, tumor resection, and discectomy with near-complete resolution of symptoms. In patients with lumbar disc herniation that improves with conservative treatment, the recurrence of symptoms should prompt a thorough review of the medical history, physical examination, and imaging studies to establish the diagnosis and prevent delay in treatment.
腰椎间盘突出是腰痛的常见原因。采用物理治疗进行保守治疗,如腰椎牵引,通常是有效的。虽然腰椎神经鞘瘤相对少见,但其临床表现与腰椎间盘突出相似,这使得诊断困难。本病例报告描述了一名51岁男性,他患有腰痛3年,被诊断为L2/L3腰椎间盘突出。腰痛通过保守治疗得到良好控制,症状逐渐改善。然而,在我们评估前两个月,症状急性加重,并伴有马尾神经综合征症状的出现。磁共振成像偶然发现L2/L3椎间盘突出部位有一个小肿瘤,这是导致腰椎管狭窄症状的原因。患者接受了椎板切除术、肿瘤切除术和椎间盘切除术,症状几乎完全缓解。对于经保守治疗症状改善的腰椎间盘突出患者,症状复发时应彻底回顾病史、进行体格检查和影像学检查以明确诊断并防止治疗延误。