He Fuliang, Xing Tong, Yu Fang, Li Hongchuan, Fang Xiutong, Song Hongxing
Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University Beijing, China.
Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University Beijing, China.
Int J Clin Exp Med. 2015 Jul 15;8(7):10760-6. eCollection 2015.
In order to help diagnose and deal with the fetal aortic diseases in time, we retrospectively reviewed 8 patients who presented with cauda equina syndrome (CES) but actually suffered from low spinal nerve ischemia due to aortic diseases.
8 patients were initially diagnosed as CES. 7 patients were confirmed with aortic diseases. 1 patient was confirmed with aortic saddle embolism post emergent laminectomy. Relief of CES symptoms was evaluated during preoperation and follow-up period.
1 patient was diagnosed as aortic dissection and 5 patients as AAA. These 6 patients underwent endovascular aortic repair (EVAR). The CES was relieved in 5-10 d post procedure. The 7th patient was diagnosed with acute abdominal aortic occlusion and then underwent catheter directed thrombolysis with recombinant tissue plasminogen activator (rTPA) for 20 h and CES disappeared. The JOA scores of the 7 patients were recovered from preoperative 15.14±1.21 to 21.00±2.16 within 5-10 d (P<0.01), and evaluated to be 24.12±1.34, 25.88±1.21 and 26.29±1.11 at 3 m-, 6 m- and 12 m-follow-up point, respectively. The 8th patient was initially diagnosed as lumbar spinal stenosis and lumbar disc herniation. The patient underwent emergent vertebral canal decompression and presented with serious CES symptoms. CTA confirmed that the patient had been suffered from aortic saddle embolism (ASE).
CES caused by abdominal aortic diseases is a special event with fetal consequences if it is not recognized and treated promptly. Orthopedists and neurosurgeons should pay attentions particularly to this issue to preserve the cauda equina functions to their maximums.
为了及时帮助诊断和处理胎儿主动脉疾病，我们回顾性分析了8例表现为马尾综合征（CES）但实际因主动脉疾病导致低位脊神经缺血的患者。
8例患者最初被诊断为CES。7例患者确诊为主动脉疾病。1例患者在急诊椎板切除术后确诊为主动脉鞍区栓塞。在术前和随访期间评估CES症状的缓解情况。
1例患者被诊断为主动脉夹层，5例患者被诊断为腹主动脉瘤（AAA）。这6例患者接受了血管腔内主动脉修复术（EVAR）。术后5 - 10天CES症状缓解。第7例患者被诊断为急性腹主动脉闭塞，随后接受重组组织型纤溶酶原激活剂（rTPA）导管定向溶栓20小时，CES消失。7例患者的日本骨科协会（JOA）评分在5 - 10天内从术前的15.14±1.21恢复到21.00±2.16（P<0.01），在术后3个月、6个月和12个月的随访点分别评估为24.12±1.34、25.88±1.21和26.29±1.11。第8例患者最初被诊断为腰椎管狭窄和腰椎间盘突出症。该患者接受了急诊椎管减压术，但出现了严重的CES症状。CT血管造影（CTA）证实该患者患有主动脉鞍区栓塞（ASE）。
由腹主动脉疾病引起的CES是一种特殊情况，如果不及时识别和治疗会产生严重后果。骨科医生和神经外科医生应特别关注这个问题，以最大程度地保留马尾神经功能。
