Department of Spine Surgery, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Zhongshan Road No.321, Nanjing, 210008, China.
Eur Spine J. 2012 Jun;21 Suppl 4(Suppl 4):S467-70. doi: 10.1007/s00586-011-2095-9. Epub 2011 Dec 1.
Isolated intraspinal extradural tuberculous granuloma (IETG) without radiological evidence of vertebral involvement is uncommon, especially rare in cervical spine.
We report a case of cervical IETG without bone involvement in a patient with neurological deficit. The patient suffered from progressive neurological dysfunction. MRI of cervical spine revealed an intraspinal extradural mass, and the spinal cord was edematous because of the compression. Thus C2-C4 laminectomy was performed and extradural mass was excised.
The excised extradural mass was confirmed to be tuberculous granuloma through pathologic examination. Antituberculous drugs were administrated with a regular follow-up. Excellent clinical outcomes were achieved.
The isolated IETG, although a rare entity, should be considered in the differential diagnosis of the intraspinal mass, especially in patients with spinal cord compression and a history of tuberculosis. If there is a progressing neurological deficit, a combination of surgical and anti-tuberculous treatment should be the optimal choice.
孤立性硬脊膜外脊柱结核性肉芽肿(IETG)而无影像学证据的椎体受累不常见,特别是在颈椎中更为罕见。
我们报告了一例颈椎 IETG 病例,患者有神经功能缺损而无骨受累。患者出现进行性神经功能障碍。颈椎 MRI 显示硬脊膜外肿块,脊髓因受压而水肿。因此进行了 C2-C4 椎板切除术并切除了硬脊膜外肿块。
通过病理检查证实切除的硬脊膜外肿块为结核性肉芽肿。给予抗结核药物治疗,并定期随访。取得了极佳的临床效果。
孤立性 IETG 虽然罕见,但在硬脊膜内肿块的鉴别诊断中应考虑到这一点,特别是在有脊髓压迫和结核病病史的患者中。如果存在进行性神经功能缺损,手术和抗结核治疗的联合应是最佳选择。