Department of Orthopedic Surgery, Spine Center, East West Neomedical Center, Kyung Hee University School of Medicine, 149 Sangil-dong, Kangdong-gu, Seoul, Korea.
Spine (Phila Pa 1976). 2009 Aug 15;34(18):E673-6. doi: 10.1097/BRS.0b013e3181b0b3ac.
A case report of a spinal subarachnoid hematoma (SSAH) associated with hyperextension fractures complicating diffuse idiopathic skeletal hyperostosis (DISH).
To report the first case of a SSAH complicating spinal fracture in DISH.
A SSAH is very rare condition. And there had been several reports on spinal fractures in DISH through fused spinal segments, but no report related with SSAH associated with spinal fracture in DISH patient.
A 78-year-old female patient was admitted for pain in the back and lower limbs and paraparesis after being fall on her back. On simple radiographs, DISH with anterior cortical bone deficit and increased height were presented at the level of L1. MR and Myelography computed tomography images revealed an extension type of fracture with an irregular shaped subarachnoid hematoma within the dura. Differential diagnosis from infection or tumorous condition was required.
Durotomy and 1 to 2 laminectomy was performed to improve neurologic symptoms. The posterior yellow ligament was seen partially ossified and adhered to dura without dura tear. The hematoma was found adherent to the nerve roots of the cauda equina and pia mater. After posterior segmental screw instrumentation and fusion from T10 to L3, anterior interbody fusion was performed with extrapleural approach after dissected the 11th rib, using L1 corpectomy and titanium mesh cages. There was no evidence of infection or tumor. After surgery, motor and sensory function of the lower limbs improved remarkably with solid bony union.
The first case of a SSAH complicating spinal fracture in DISH is presented. The patient was successfully treated with a staged operation including posterior decompression with fusion and anterior interbody fusion.
一例与弥漫特发性骨肥厚（DISH）相关的伸展性骨折并发脊髓蛛网膜下腔血肿（SSAH）的病例报告。
报告首例 DISH 并发脊髓骨折的 SSAH 病例。
SSAH 是一种非常罕见的情况。已有几篇关于 DISH 中通过融合脊柱节段发生的脊柱骨折的报道，但没有关于 DISH 患者并发与脊髓骨折相关的 SSAH 的报道。
一名 78 岁女性患者因背部和下肢疼痛以及截瘫摔倒后入院。在简单的 X 光片上，在 L1 水平呈现出前皮质骨缺失和高度增加的 DISH。MR 和脊髓造影计算机断层扫描图像显示硬膜内存在伸展型骨折和不规则形状的蛛网膜下腔血肿。需要与感染或肿瘤情况进行鉴别诊断。
进行硬脊膜切开术和 1 至 2 个椎板切除术以改善神经症状。部分后黄韧带骨化并黏附于硬脊膜，但无硬脊膜撕裂。血肿发现黏附于马尾神经根和软脑膜。在 T10 至 L3 进行后节段螺钉固定和融合后，采用经第 11 肋切开的胸腔外入路进行前路椎体间融合，使用 L1 椎体切除术和钛网笼。无感染或肿瘤证据。手术后，下肢的运动和感觉功能显著改善，骨融合牢固。
报告了首例 DISH 并发脊髓骨折的 SSAH 病例。患者通过分期手术成功治疗，包括后路减压融合和前路椎体间融合。
