Department of Orthopaedic Surgery, Nishitaga National Hospital, Sendai, Japan.
Ups J Med Sci. 2011 May;116(2):133-7. doi: 10.3109/03009734.2010.526722. Epub 2010 Nov 24.
Case-series study.
To describe the clinical presentation, characteristic findings of imaging studies, and treatment of lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis. BACKGROUND. Lumbar lesions in rheumatoid arthritis are relatively rare, with a limited number of systemic reports.
Six patients with lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis were treated. The patients were all women with a mean age of 69 years and mean rheumatoid arthritis duration of 15 years. The medical records and imaging studies of all patients were reviewed.
The affected nerve roots were L4 in four patients and L3 in two patients. Foraminal stenosis was not demonstrated in magnetic resonance images in four of the six patients. Selective radiculography with nerve root block reproduced pain, manifested blocking effect, and demonstrated compression of the nerve root by the superior articular process of the lower vertebra in all patients. Conservative treatment was performed on one patient, and surgery was conducted for the rest of the five patients; radiculopathy was improved in all patients.
Lumbar foraminal stenosis is a characteristic pathology of rheumatoid arthritis, and should be kept in mind in the diagnosis of lumbar radiculopathy. Selective radiculography is useful in the diagnosis of affected nerve roots.
病例系列研究。
描述类风湿关节炎引起的椎间孔狭窄性腰椎神经根病的临床特征、影像学表现和治疗方法。背景：类风湿关节炎的腰椎病变相对少见，仅有少数系统性报道。
对 6 例由类风湿关节炎引起的椎间孔狭窄性腰椎神经根病患者进行治疗。所有患者均为女性，平均年龄 69 岁，平均类风湿关节炎病程 15 年。回顾所有患者的病历和影像学资料。
4 例患者的受累神经根为 L4，2 例患者为 L3。6 例患者中，有 4 例磁共振成像未显示椎间孔狭窄。选择性神经根造影结合神经根阻滞可重现疼痛，表现出阻滞效应，并显示下位椎体上关节突对神经根的压迫，所有患者均如此。对 1 例患者进行保守治疗，其余 5 例患者进行手术治疗；所有患者的神经根病均得到改善。
腰椎椎间孔狭窄是类风湿关节炎的特征性病变，在诊断腰椎神经根病时应予以考虑。选择性神经根造影对受累神经根的诊断具有重要价值。
