Department of Neurosurgery, Ewha Womans University School of Medicine, Mokdong Hospital, 911-1 Mok-dong, Yangcheon-gu, Seoul 158-710, Korea.
Eur Spine J. 2010 Jul;19 Suppl 2(Suppl 2):S211-5. doi: 10.1007/s00586-010-1389-7. Epub 2010 Apr 7.
Leprosy is a chronic infectious disease caused by the Mycobacterium leprae that leads to leprotic neuropathy involving the peripheral nerve and several characteristic skin lesions. Skeletal involvement can occur in peripheral joints, such as the wrist and the ankle. However, there is no report of an axial leprotic lesion involving the spine or paraspinal soft tissue. The authors report the first case of a leprotic cervical lesion involving the axial skeletal system. A 48-year-old male presented with neck pain and severe pain in the right suprascapular area and left arm. Preoperative MRI of the cervical spine revealed signal changes in the prevertebral soft tissue at the level of the C3, 4, 5 vertebral bodies. There were a lower signal intensity on T1-weighted image and high signal intensity on T2WI of the bone marrow at the level of the C5 and C6 vertebral bodies, and a C5/6 segmental ossification of the posterior longitudinal ligament. There were herniated cervical disc on the left C5/6 with C6 root and the right side of C6/7 with a C7 root compression. He was previously diagnosed with leprosy when he was 14 years old and received treatment intermittently over the course of 7 years. But patient did not disclose his past history. Surgical intervention was conducted using an anterior cervical approach. An incision was made in the anterior longitudinal ligament at C5/6, and a pinkish gray friable gelatinous material was observed on the C5/6 disc and on the anterior lower one-third surface of the C5 vertebral body. Specimens were obtained and subjected to pathological evaluation and microbiological culture. After C5/6 and C6/7 discectomies, nerve root decompression and autologous iliac bone grafting were performed at the C5/6 and C6/7 levels. The C5-6-7 vertebrae were fixed with an Atlantis cervical locking plate and a screw system. The pathological report indicated chronic inflammation with heavy plasma cell infiltration on the specimen. We sent the specimens to the Institute of Hansen's Disease, and polymerase chain reaction for leprosy tested positive. After surgery, his pain disappeared and he was given a prescription for antileprotic drugs. The authors describe the first case of leprotic cervical spondylodiscitis that was operatively treated in a 48-year-old patient with known leprosy history since his 14 years old.
麻风病是一种由麻风分枝杆菌引起的慢性传染病，可导致周围神经受累和多种特征性皮肤损伤。骨骼受累可发生在外周关节，如腕关节和踝关节。然而，目前尚无报道称脊柱或脊柱旁软组织存在轴索性麻风病变。作者报告首例涉及脊柱轴骨骼系统的麻风性颈椎病变。一名 48 岁男性因颈部疼痛和右侧肩胛上区及左上肢剧烈疼痛就诊。颈椎术前 MRI 显示 C3、4、5 椎体前方软组织信号改变。C5、C6 椎体骨髓在 T1WI 呈低信号，T2WI 呈高信号，C5/6 节段后纵韧带骨化。左侧 C5/6 神经根与 C6 神经根和右侧 C6/7 神经根与 C7 神经根受压处有颈椎间盘突出。他 14 岁时被诊断患有麻风病，并间断接受了 7 年的治疗。但患者未透露其既往病史。采用前路颈椎入路进行手术干预。在 C5/6 处做前纵韧带切口，在 C5/6 椎间盘和 C5 椎体前下 1/3 表面观察到粉红色、灰白色易碎胶状物质。取标本进行病理评估和微生物培养。在 C5/6 和 C6/7 椎间盘切除后，在 C5/6 和 C6/7 水平进行神经根减压和自体髂骨植骨。使用 Atlantis 颈椎锁定板和螺钉系统固定 C5-6-7 椎体。病理报告显示标本上有慢性炎症，浆细胞大量浸润。我们将标本送到麻风病研究所，聚合酶链反应检测麻风病呈阳性。手术后，他的疼痛消失，并给他开了抗麻风病药物。作者描述了首例已知麻风病史（14 岁时发病）的 48 岁患者经手术治疗的麻风性颈椎脊椎炎病例。
