Ohashi T, Morimoto T, Sakaki T, Kyoi K, Utsumi S, Yonezawa Y, Fujita T
Department of Neurosurgery, Nara Medical University, School of Medicine, Kashihara, Japan.
No Shinkei Geka. 1990 Aug;18(8):773-7.
A rare case of achondroplasia showing diffuse spinal canal stenosis is presented. A 39-year-old woman was admitted to our hospital because of numbness of lower extremities and intermittent claudication. The patient's height was 121cm and she had the typical clinical features of an achondroplastic dwarf. Neurological examination revealed spastic paraparesis, and sensory impairment below the level of T11 in the left side and L1 in the right. A plain X-ray feature of the spine showed spinal canal stenosis. The interpedicular distances were short in all vertebrae, and especially more prominent in the caudal lumbar region. The sacrum laid horizontally and the sacral angle was narrower than normal case. Myelography and computed tomographic myelography demonstrated severe stenosis of the subarachnoid space at the level of T9-11. Laminectomy was performed from the inferior half of T9 to T11. The yellow ligaments were prominently hypertrophic and these were removed as far as possible. Postoperatively, the weakness of the lower extremities was improved immediately, but numbness remained. Five months after the operation, she suffered from urinary dysfunction, so further laminectomy from T12 to L5 was performed. Also in this operation, hypertrophic yellow ligament was pathognomonic. Following this operation the patient had a good recovery course and returned to work.
本文报告一例罕见的软骨发育不全伴弥漫性椎管狭窄病例。一名39岁女性因下肢麻木和间歇性跛行入院。患者身高121cm，具有典型的软骨发育不全性侏儒临床特征。神经学检查发现痉挛性截瘫，左侧T11以下及右侧L1以下感觉障碍。脊柱X线平片显示椎管狭窄。所有椎体的椎弓根间距均较短，在腰骶部尤为明显。骶骨呈水平位，骶角比正常情况窄。脊髓造影和计算机断层脊髓造影显示T9 - 11水平蛛网膜下腔严重狭窄。行T9下半部至T11椎板切除术。黄韧带明显肥厚，尽可能予以切除。术后下肢无力立即改善，但仍有麻木感。术后5个月，患者出现排尿功能障碍，因此又行了T12至L5的椎板切除术。此次手术中，肥厚的黄韧带也很典型。此次手术后患者恢复良好并重返工作岗位。
