Kumar Bijoy Mohan, Munakomi Sunil
Department of Neurosurgery, College of Medical Sciences, Chitwan, Nepal.
F1000Res. 2015 Aug 4;4:467. doi: 10.12688/f1000research.6865.1. eCollection 2015.
Herein we discuss a case of a 55 year old male presenting with history suggestive of sciatica on the left leg. Straight leg raising (SLR) test was positive at 45 degrees on the left side. His ankle reflex was absent and the power of extensor hallusus longus (EHL) was 4/5 on the same side. MRI lumbosacral spine revealed left paramedian disc prolapsed on L4/L5 level with spinal canal diameter of 9mm.However since his bilateral extensor digitorm brevis (EDB) were wasted, we suspected associated lumbar canal stenosis and thereby opted for laminectomy and discectomy in this case. Intraoperatively dural wasting, hypertrophied facets and narrow canal were confirmed. Laminectomy, medial facectectomy and discectomy were carried out. The patient recovered uneventfully with resolution of his sciatica-like pain. Bilateral EDB wasting thereby provides a clinical clue to the underlying lumbar canal stenosis and can help in making correct therapeutic decisions.
在此,我们讨论一例55岁男性病例,其病史提示左腿坐骨神经痛。左侧直腿抬高(SLR)试验在45度时呈阳性。其同侧踝反射消失,拇长伸肌(EHL)肌力为4/5。腰骶部脊柱MRI显示L4/L5水平左侧旁正中椎间盘突出,椎管直径为9mm。然而,由于其双侧趾短伸肌(EDB)萎缩,我们怀疑伴有腰椎管狭窄,因此在该病例中选择了椎板切除术和椎间盘切除术。术中证实存在硬脊膜萎缩、关节突肥大和椎管狭窄。实施了椎板切除术、内侧关节突切除术和椎间盘切除术。患者恢复顺利,坐骨神经痛样疼痛消失。双侧EDB萎缩因此为潜在的腰椎管狭窄提供了临床线索,并有助于做出正确的治疗决策。