Grammetbauerová S
Neurologická klinika FN, Praha.
Cesk Neurol Neurochir. 1991 Sep;54(4):204-7.
The author analyzed a group of 17 patients with spinal tumours with symptoms of compression of the conus or cauda. Early clinical symptoms were sought and the entire clinical course before surgery was evaluated. The objective clinical finding was compared with the surgical one. Causes of diagnostic errors were analyzed. Most frequently a discogenic or other vertebrogenic cause of complaints was suspected. In all patients a local or root symptoms were the first manifestation of the disease. From the investigation ensues that a tumour must be considered when pain radiates into both lower extremities, in case of striking stiffness of the spine up to the neck and in case of damage of the higher lumbar roots. Tumours are more frequently located higher than prolapsed discs with manifestations of caudal compression. When bone structures are affected in primary tumours, the objective clinical finding may be very sparse. Tumours at the borderline of Th-L may be manifested by root symptoms L5 or S1. During PMG attention is focused lower, usually a prolapsed disc of L4/5 or L5/S1 is suspected and the tumour may be missed. Values of cerebrospinal fluid proteins in fluid collected at the lumbar level were high in all patients of the group.
作者分析了一组17例患有脊髓圆锥或马尾受压症状的脊柱肿瘤患者。探寻早期临床症状，并评估手术前的整个临床过程。将客观临床发现与手术结果进行比较。分析诊断错误的原因。最常怀疑的是椎间盘源性或其他脊椎源性主诉原因。在所有患者中，局部或根性症状是疾病的首发表现。从调查结果可知，当疼痛放射至双下肢、脊柱直至颈部出现明显僵硬以及高位腰神经根受损时，必须考虑肿瘤。与表现为马尾受压的椎间盘突出相比，肿瘤更常位于较高位置。当原发性肿瘤累及骨骼结构时，客观临床发现可能非常少。胸腰段交界处的肿瘤可能表现为L5或S1神经根症状。在体格检查时，注意力集中在较低部位，通常怀疑是L4/5或L5/S1椎间盘突出，可能会漏诊肿瘤。该组所有患者腰椎水平采集的脑脊液蛋白值均较高。
