Department of Neurosurgery, Chang Gung Memorial Hospital, Change Gung University, Taoyuan, Taiwan, Republic of China.
Spine (Phila Pa 1976). 2010 Mar 1;35(5):E149-51. doi: 10.1097/BRS.0b013e3181bee8a7.
Case report and review of the literature.
To report a patient presenting with Brown-Sequard syndrome due to cervical intradural disc herniation after spinal manipulation therapy.
Spinal manipulation therapy (SMT) is often used by people with neck pain or discomfort as an alternative therapy due to its claimed less invasiveness and comparable efficacy. However, excessive manipulations are reported to cause rare but serious complications such as tetraplegia, vertebral artery dissection, epidural hematoma, and phrenic nerve injury.
Clinical history, physical examination, and radiographic findings of the patient were described. Anterior cervical discectomy at the C3/C4 level and interbody fusion with a Caspar plate-screw system for fixation, were performed.
A favorable surgical outcome was obtained. The Brown-Sequard syndrome improved and the patient regained full muscle power at a 3-months follow-up.
Cervical intradural disc herniation after SMT is rare and most often cause Brown-Sequard syndrome. Definite diagnosis and prompt surgery usually achieves a satisfactory outcome. Anterior discectomy with interbody fusion is recommended. The OPLL associated with degenerative disc reminds us of the increased risk of intradural disc herniation. Those high-risk groups should be more cautious with spinal manipulation therapy due to its serious sequelae.
病例报告及文献复习。
报告 1 例因脊髓推拿治疗后颈椎硬膜内椎间盘突出导致 Brown-Sequard 综合征的患者。
由于其声称的侵袭性较小和相当的疗效，脊髓推拿治疗（SMT）常被有颈部疼痛或不适的人作为替代疗法。然而，过度的推拿被报道会导致罕见但严重的并发症，如四肢瘫痪、椎动脉夹层、硬膜外血肿和膈神经损伤。
描述了患者的临床病史、体格检查和影像学发现。进行了 C3/C4 水平前路颈椎间盘切除术和 Caspar 板螺钉系统椎间融合固定。
获得了良好的手术结果。Brown-Sequard 综合征改善，患者在 3 个月随访时恢复了全部肌肉力量。
脊髓推拿治疗后颈椎硬膜内椎间盘突出罕见，多引起 Brown-Sequard 综合征。明确诊断和及时手术通常可获得满意的结果。推荐前路椎间盘切除术和椎间融合术。与退行性椎间盘相关的 OPLL 提醒我们硬膜内椎间盘突出的风险增加。这些高危人群因严重的后遗症应更加谨慎地进行脊髓推拿治疗。
