Epstein J A, Marc J A, Hyman R A, Khan A, Mardayat M
Spine (Phila Pa 1976). 1979 Mar-Apr;4(2):121-8. doi: 10.1097/00007632-197903000-00005.
It has been our practice to perform total myelography in all cases of lumbar disc disease including the various syndromes of spinal stenosis, because experience has indicated that myelographic abnormalities in the cervical and thoracic areas could have clinical importance despite the presence of gross changes in the lumbar region. Failure to establish a definite diagnosis by restricted lumbar myelography makes it mandatory to evaluate all levels of the spinal axis. Recently, 3 patients with thoracic spinal cord tumors presented with primary signs and symptoms of lumbar spine disorders. Evidence of spinal cord disease was minimal and could be readily overlooked. Total myelography disclosed varying degrees of lumbar spinal pathology, but also showed evidence of lesions in the thoracic region. One proved to be an intramedullary astrocytoma of the spinal cord, and two were schwannomas. The symptoms of low-back pain and lumbar radiculopathy improved after excision of the schwannomas and following x-ray therapy and chemotherapy in the patient with the intramedullary neoplasm.
我们的惯例是，对所有腰椎间盘疾病病例，包括各种脊髓狭窄综合征，都进行全脊髓造影，因为经验表明，尽管腰椎区域有明显变化，但颈段和胸段脊髓造影异常可能具有临床意义。仅通过腰椎脊髓造影未能明确诊断时，就必须对脊柱轴的所有节段进行评估。最近，3例胸段脊髓肿瘤患者最初表现为腰椎疾病的体征和症状。脊髓疾病的证据很少，很容易被忽视。全脊髓造影显示出不同程度的腰椎病理改变，但也显示出胸段有病变的证据。其中1例被证实为脊髓内星形细胞瘤，2例为神经鞘瘤。神经鞘瘤切除后，以及脊髓内肿瘤患者接受X线治疗和化疗后，腰痛和腰椎神经根病的症状有所改善。
