Kang Kyusik, Lee Jeong-Hee, Kim Hoon-Gu
Department of Neurology, Eulji General Hospital, Seoul, Republic of Korea.
Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
J Spinal Cord Med. 2013 Nov;36(6):695-9. doi: 10.1179/2045772312Y.0000000087. Epub 2013 Apr 12.
Referred pain has been observed in some patients after cordotomy, wherein noxious stimulus applied to a region rendered analgesic by cordotomy produces pain at a spot different from the one where the noxious stimulus is applied. We report a patient who had intramedullary spinal cord metastasis of extraskeletal small cell osteosarcoma, a rare form of metastatic disease, and experienced contralateral referred pain.
Initially, the patient had a mass in the left posterior neck region and later developed a large extradural mass at the C3-C7 level. The masses were excised, and the histological findings led to a diagnosis of small cell osteosarcoma. He underwent chemotherapy and radiation therapy. He experienced numbness in his left leg; subsequently, the numbness slowly spread up the thigh to the left side of the abdomen. When pinched in the numb area on the left side of the body, he felt as though he had been pinched in both that area and the corresponding area on the right side. A magnetic resonance imaging scan showed an enhancing lesion in the right side of the cord at the C6-C7 level.
CONCLUSION/CLINICAL RELEVANCE: An intramedullary spinal cord metastasis can arise from primary extraskeletal small cell osteosarcoma and cause contralateral referred pain, especially in a mirror-image location. Contralateral referred pain may be caused by a subsidiary pathway comprising ascending chains of short neurons that link the dorsal horn neurons longitudinally and latitudinally.
在脊髓切开术后，部分患者出现了牵涉痛，即对脊髓切开术所致镇痛区域施加有害刺激时，疼痛出现在与施加有害刺激部位不同的位置。我们报告了1例患有骨外小细胞骨肉瘤髓内脊髓转移（一种罕见的转移疾病形式）并经历对侧牵涉痛的患者。
最初，该患者左后颈部有一肿块，随后在C3 - C7水平出现一个巨大的硬膜外肿块。切除肿块后，组织学检查结果确诊为小细胞骨肉瘤。他接受了化疗和放疗。他左腿出现麻木；随后，麻木感逐渐从大腿向上蔓延至腹部左侧。当捏身体左侧的麻木区域时，他感觉好像在该区域以及右侧的相应区域都被捏了一样。磁共振成像扫描显示C6 - C7水平脊髓右侧有一强化病变。
结论/临床意义：原发性骨外小细胞骨肉瘤可发生髓内脊髓转移并引起对侧牵涉痛，尤其是在镜像位置。对侧牵涉痛可能由一个辅助通路引起，该通路由纵向和横向连接背角神经元的短神经元上升链组成。
