Shimizu Fumitaka, Kawai Motoharu, Koga Michiaki, Ogasawara Jun-ichi, Negoro Kiyoshi, Kanda Takashi
Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine.
Rinsho Shinkeigaku. 2008 Oct;48(10):733-6. doi: 10.5692/clinicalneurol.48.733.
We report a 70-year-old man, who developed painful involuntary muscle contraction of the left leg after the lumbar discectomy, which exacerbated after a vertebral fracture of Th12. This involuntary movement was accompanied with the abnormal position of left leg simulating triple flexion response, and was induced by active or passive movement of his left knee and foot joints. Several drugs including benzodiazepines and dantrolene were ineffective, although treatment with baclofen or carbamazepine was effective. These findings suggest that hyperexcitability of the anterior horn cells following the disturbance of spinal inhibitory interneurons was involved. Electophysiological studies suggested the disturbance of left lumber nerve roots. The spinal root blocks from L3 to S1 were performed, after which the painful involuntary muscle spasm was resolved. The lumbar sympathetic ganglia block was also effective; suggesting that abnormal afferent neuronal input to spinal cord was caused by the nerve root trauma which triggered the formation of secondary abnormal network in the spine. Lumbar sympathetic ganglia block should be recommended to a therapeutic option for the refractory painful muscle spasm of the leg.
我们报告了一名70岁男性，他在腰椎间盘切除术后出现左腿疼痛性不自主肌肉收缩，在第12胸椎椎体骨折后加重。这种不自主运动伴有左腿异常姿势，类似三联屈曲反应，并由左膝和踝关节的主动或被动运动诱发。包括苯二氮䓬类药物和丹曲林在内的几种药物均无效，尽管使用巴氯芬或卡马西平治疗有效。这些发现提示脊髓抑制性中间神经元受干扰后前角细胞兴奋性增高与之有关。电生理研究提示左侧腰神经根受干扰。进行了从L3至S1的脊神经根阻滞，之后疼痛性不自主肌肉痉挛得以缓解。腰交感神经节阻滞也有效；提示神经根损伤导致异常传入神经向脊髓输入，进而触发脊柱继发性异常网络的形成。对于难治性腿部疼痛性肌肉痉挛，应推荐腰交感神经节阻滞作为一种治疗选择。
