Hooten W Michael, Hogan Michael S, Sanemann Thomas C, Maus Timothy J
Department of Anesthesia, Mayo Clinic College of Medicine, , Rochester, MN 55905, USA.
Pain Physician. 2008 Jan;11(1):87-90.
Congenital lumbar spinal stenosis is an uncommon condition that is often asymptomatic in young adults. Herein, we document the first reported occurrence of acute radicular back pain and associated congenital lumbar spinal stenosis in a healthy 24-year-old woman undergoing an epidural blood patch for treatment of a post-dural puncture headache related to an accidental dural puncture sustained during placement of a labor epidural catheter. The acute pain symptoms were elicited twice with injection of less than 1 mL of fluid into the epidural space during the fluoroscopically assisted epidural blood patch. Subsequent magnetic resonance imaging of the lumbar spine demonstrated shortened pedicle length consistent with severe congenital lumbar spinal stenosis and prominent epidural fat. We speculate that the transient increase in pressure within the epidural compartment following injection of a small amount of fluid could have compressed neural structures resulting in severe radicular pain. The prominent epidural fat could have prevented rapid disbursement of the injected fluid which could have further served to propagate the pressure increase throughout the epidural compartment. The unique radiographic features of congenital spinal stenosis could predispose some patients with this unrecognized condition to develop acute pain upon injection of a small amount of fluid into the epidural compartment. Unrecognized congenital lumbar spinal stenosis is an important addition to the differential diagnosis of acute radicular pain elicited during an epidural blood patch in previously asymptomatic patients.
先天性腰椎管狭窄是一种罕见的疾病，在年轻人中通常无症状。在此，我们记录了首例报告的病例，一名24岁健康女性在接受硬膜外血贴治疗因分娩硬膜外导管置入期间意外硬膜穿刺导致的硬膜穿刺后头痛时，出现急性根性背痛并伴有先天性腰椎管狭窄。在荧光透视辅助硬膜外血贴过程中，向硬膜外间隙注入少于1 mL液体时，急性疼痛症状出现了两次。随后的腰椎磁共振成像显示椎弓根长度缩短，符合严重先天性腰椎管狭窄，硬膜外脂肪突出。我们推测，注入少量液体后硬膜外腔压力的短暂升高可能压迫了神经结构，导致严重的根性疼痛。突出的硬膜外脂肪可能阻止了注入液体的快速扩散，这可能进一步促使压力在整个硬膜外腔升高。先天性椎管狭窄独特的影像学特征可能使一些患有这种未被识别疾病的患者在向硬膜外腔注入少量液体时出现急性疼痛。未被识别的先天性腰椎管狭窄是先前无症状患者在硬膜外血贴期间引发急性根性疼痛鉴别诊断中的一个重要补充。
