Tanaka Masato, Ikuma Hisanori, Nakanishi Kazuo, Sugimoto Yoshihisa, Misawa Haruo, Takigawa Tomoaki, Ozaki Toshifumi
Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata, Okayama, 700-8558, Japan.
Eur Spine J. 2008 Sep;17 Suppl 2(Suppl 2):S263-6. doi: 10.1007/s00586-007-0537-1. Epub 2007 Nov 7.
We present an extremely rare case of traumatic spinal cord herniation due to a brachial plexus avulsion injury and provide a review of the literature of spinal cord herniation. Spinal cord herniation is an uncommon condition that can occur spontaneously or as a result of surgery or trauma. This condition often presents with symptoms and signs as Brown-Séquard syndrome. Traumatic pseudomeningoceles after a brachial plexus avulsion injury have been reported. But transdural herniation of the spinal cord into this pseudomeningocele is an extremely rare and poorly documented condition. There is only two reports of this condition in a thoracic case. The authors report the case of a 22-year-old man presented with a 2-year history of quadriplegia. He was involved in a motorcycle accident, 3 years prior to his presentation. Four years after the initial right brachial plexus injury, he was not able to walk independently. Magnetic resonance imaging (MRI) and computerized tomography (CT) myelography revealed a lateral pseudomeningocele arising from the right C6-7 and C7-T1 intervetebral foramen and cervical spinal cord herniation into this pseudomeningocele. The patient underwent primary closure of pseudomeningocele to prevent spinal cord reherniation. He can walk with cane and use left arm unrestrictedly at the 2-year follow-up examination. Spinal cord herniation following traumatic nerve root avulsion is extremely rare but it should be considered in the differential diagnosis of patients presenting with delayed myelopathy or Brown-Séquard syndrome.
我们报告了一例极为罕见的因臂丛神经撕脱伤导致的创伤性脊髓疝，并对脊髓疝的文献进行了综述。脊髓疝是一种不常见的病症，可自发发生，也可因手术或创伤引起。这种病症常表现出如布朗 - 塞卡尔综合征的症状和体征。臂丛神经撕脱伤后创伤性假性脑脊膜膨出已有报道。但脊髓经硬膜疝入这种假性脑脊膜膨出是一种极为罕见且记录甚少的病症。仅有两例关于胸椎病例的报道。作者报告了一名22岁男性患者，有四肢瘫痪2年的病史。他在就诊前3年曾发生摩托车事故。初次右臂丛神经损伤4年后，他无法独立行走。磁共振成像（MRI）和计算机断层扫描（CT）脊髓造影显示，一个外侧假性脑脊膜膨出从右侧C6 - 7和C7 - T1椎间孔处形成，颈段脊髓疝入该假性脑脊膜膨出内。患者接受了假性脑脊膜膨出的一期闭合手术以防止脊髓再次疝出。在2年的随访检查中，他能够拄拐杖行走，且左臂使用不受限制。创伤性神经根撕脱伤后发生脊髓疝极为罕见，但在出现延迟性脊髓病或布朗 - 塞卡尔综合征的患者的鉴别诊断中应予以考虑。
