Hirohashi Nori, Sakai Toshinori, Sairyo Koichi, Oba Koichi, Higashino Kosaku, Katoh Shinsuke, Yasui Natsuo
Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
J Neurosurg Spine. 2007 Sep;7(3):352-6. doi: 10.3171/SPI-07/09/352.
The authors report on a 51-year-old woman with a 9-year history of rheumatoid arthritis (RA) who presented with symptomatic rheumatoid nodules in the lumbar extradural region with compression on the L-5 nerve roots bilaterally. She had also suffered from dysesthesia in the right lower leg and intermittent claudication. Magnetic resonance imaging revealed masses compressing the dural sac, and on lumbar myelography and computed tomography myelography a filling defect at L4-5 was revealed, which was compressing the dural sac posterolaterally on both sides. The masses were surgically removed. On histological examination the typical characteristics of rheumatoid nodules were found. Soon after the operation all of the patient's symptoms disappeared. There have been few reports on extradural rheumatoid nodules. Patients with RA usually complain of articular symptoms, and in fact the patient in the present study had been referred to the authors' institution for total hip arthroplasty. However, various symptoms other than those arising from articular lesions were found clinically. The authors believe that if patients with RA are also examined for extraarticular lesions, it is likely that these will be more frequently detected.
作者报告了一名51岁患有类风湿关节炎（RA）9年的女性，其腰椎硬膜外区域出现有症状的类风湿结节，双侧L5神经根受压。她还患有右小腿感觉异常和间歇性跛行。磁共振成像显示有肿块压迫硬脊膜囊，腰椎脊髓造影和计算机断层扫描脊髓造影显示L4 - 5处有充盈缺损，双侧后外侧压迫硬脊膜囊。这些肿块通过手术切除。组织学检查发现了类风湿结节的典型特征。手术后不久，患者所有症状均消失。关于硬膜外类风湿结节的报道很少。RA患者通常主诉关节症状，事实上本研究中的患者因全髋关节置换术被转诊至作者所在机构。然而，临床上发现了除关节病变引起的症状之外的各种症状。作者认为，如果对RA患者也进行关节外病变检查，很可能会更频繁地检测到这些病变。
