Flisberg Per, Thomas Owain, Geijer Bo, Schött Ulf
Department of Intensive and Perioperative Care, Lund University Hospital, 22185 Lund, Sweden.
J Med Case Rep. 2009 Nov 16;3:128. doi: 10.1186/1752-1947-3-128.
Complications after lumbar anaesthesia and epidural blood patch have been described in patients with congenital small spinal canal and increased epidural fat or epidural lipomatosis. These conditions, whether occurring separately or in combination, require magnetic resonance imaging for diagnosis and grading, but their clinical significance is still unclear.
A 35-year-old Caucasian woman who was undergoing a Caesarean section developed a longstanding L4-L5 unilateral neuropathy after the administration of spinal anaesthesia. There were several attempts to correctly position the needle, one of which resulted in paraesthesia. A magnetic resonance image revealed that the patient's bony spinal canal was congenitally small and had excess epidural fat. The cross-sectional area of the dural sac was then reduced, which left practically no free cerebrospinal fluid space.
The combination of epidural lipomatosis of varying degrees and congenital small spinal canal has not been previously discussed with spinal anaesthesia. Due to the low cerebrospinal fluid content of the small dural sac, the cauda equina becomes a firm system with a very limited possibility for the nerve roots to move away from the puncture needle when it is inserted into the dural sac. This constitutes risks of technical difficulties and neuropathies with spinal anaesthesia.
先天性小椎管、硬膜外脂肪增多或硬膜外脂肪增多症患者的腰麻和硬膜外血贴术后并发症已有报道。这些情况，无论是单独发生还是合并出现，都需要磁共振成像来进行诊断和分级，但其临床意义仍不明确。
一名35岁的白人女性在剖宫产手术中接受脊髓麻醉后出现了长期的L4-L5单侧神经病变。多次尝试正确放置穿刺针，其中一次导致感觉异常。磁共振成像显示，该患者的骨性椎管先天性狭小，硬膜外脂肪过多。随后硬膜囊的横截面积减小，几乎没有游离的脑脊液空间。
不同程度的硬膜外脂肪增多症与先天性小椎管的组合此前尚未在脊髓麻醉中讨论过。由于小硬膜囊内脑脊液含量低，马尾神经成为一个坚硬的系统，当穿刺针插入硬膜囊时，神经根远离穿刺针的可能性非常有限。这构成了脊髓麻醉技术困难和神经病变的风险。
