Rossitti S L, Roth-Vargas A A, Sperlescu A, Balbo R J
Departamento de Neuro-Psiquiatria da Faculdade de Ciências Médicas, Pontifícia Universidade Católica de Campinas, Brasil.
Arq Neuropsiquiatr. 1990 Mar;48(1):97-101. doi: 10.1590/s0004-282x1990000100014.
Lumbar-disc protrusions (LDP) constitute well-defined syndromes on clinical and anatomical grounds, and neurosurgeons are prone to rely upon the clinical signs to identify the level of disc protrusion when a "typical" case is found. Sometimes, non-contrasted computerized tomographic (CT) scans centered on the L5-S1, L4-L5 and L3-L4 interspaces and spine roentgenograms are the only special ancillary means in presurgical evaluation. We report three patients from our series, in which neoplastic spinal disease presented as classic LDP (one patient with a cauda equina schwannoma, and two with metastatic carcinoma). The cases were chosen because they posed special problems to the referred radiodiagnostic routine. Systematic CT-evaluation of the sacrum and conus medullaris zone is recommended in every patient with lumbosacral radiculopathy, and intrathecal contrast should be employed in patients with unreliable findings or normal CT-scans.
腰椎间盘突出症（LDP）在临床和解剖学上构成了明确的综合征，当发现“典型”病例时，神经外科医生倾向于依靠临床体征来确定椎间盘突出的水平。有时，以L5-S1、L4-L5和L3-L4椎间隙为中心的非增强计算机断层扫描（CT）以及脊柱X线片是术前评估中仅有的特殊辅助手段。我们报告了我们系列中的三名患者，其中肿瘤性脊柱疾病表现为典型的腰椎间盘突出症（一名患者为马尾神经鞘瘤，两名患者为转移性癌）。选择这些病例是因为它们给所提及的放射诊断常规带来了特殊问题。建议对每例腰骶神经根病患者进行骶骨和脊髓圆锥区域的系统CT评估，对于检查结果不可靠或CT扫描正常的患者应使用鞘内造影剂。
