Lee Jung-Hee, Chaichankul Chaisiri, Kang Kyung-Chung, Lee Hyun-Ho
Department of Orthopaedics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.
Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchvidhi Rd. Thung Phyathai, Ratchthewi, Bangkok, 10400, Thailand.
Eur Spine J. 2016 May;25 Suppl 1:107-12. doi: 10.1007/s00586-015-4192-7. Epub 2015 Aug 18.
It is known that sagittal compensating mechanisms are created for counteracting sagittal imbalance problems; however, they can sometimes be associated with incidents which affect the plan of management.
The purpose of this study was to report a case of the occurrence of common iliac vessel displacement into the intervertebral disc space following one of the spinal compensatory mechanisms.
The authors demonstrated this case by showing the patient history, physical examination, imaging studies, and treatment strategy as well as by reviewing some related literature.
An 81-year-old woman presented with a long history of low back pain with claudication. An upright plain radiograph and flexion-extension study demonstrated a progressive local thoracolumbar kyphosis and losing of lumbar lordosis with significant widening of the intervertebral disc space of L4-L5. An MRI scan and 3D volume rendering spiral computed tomography (3D-CT) revealed an abnormal content which was depicted as common iliac vessels inside the disc space of L4-L5. Consequently, a rare case of the occurrence of common iliac vessel displacement into the intervertebral disc space following one of the spinal compensatory mechanisms was reported.
The occurrence of vascular displacement into the intervertebral disc space related to lumbar hyperextension, as a compensating mechanism, is a rare incident but can occur. Consequently, when this mechanism presents with abnormal widening of the intervertebral disc space, especially at the low lumbar level, it should raise surgeon's concern about the probability of vascular injury when performing a disc procedure. Thorough investigation with imaging studies and selecting the optimum surgical treatment are warranted.
已知矢状面代偿机制是为抵消矢状面失衡问题而产生的；然而，它们有时可能与影响治疗计划的事件相关。
本研究的目的是报告一例因脊柱代偿机制之一导致髂总血管移位至椎间盘间隙的病例。
作者通过展示患者病史、体格检查、影像学研究、治疗策略以及回顾一些相关文献来阐述该病例。
一名81岁女性，有长期下腰痛伴间歇性跛行病史。站立位平片和屈伸位研究显示局部胸腰椎进行性后凸，腰椎前凸消失，L4-L5椎间盘间隙明显增宽。磁共振成像（MRI）扫描和三维容积再现螺旋计算机断层扫描（3D-CT）显示L4-L5椎间盘间隙内有异常结构，表现为髂总血管。因此，报告了一例因脊柱代偿机制之一导致髂总血管移位至椎间盘间隙的罕见病例。
作为一种代偿机制，与腰椎过度伸展相关的血管移位至椎间盘间隙的情况虽罕见但可能发生。因此，当这种机制表现为椎间盘间隙异常增宽，尤其是在腰椎低位时，在进行椎间盘手术时应引起外科医生对血管损伤可能性的关注。有必要通过影像学研究进行全面评估并选择最佳手术治疗方案。
