Sawai Toshiyuki, Nakahira Junko, Minami Toshiaki
Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
J Clin Anesth. 2016 Aug;32:169-71. doi: 10.1016/j.jclinane.2016.02.025. Epub 2016 Apr 20.
Total paraplegia after epidural or spinal anesthesia is extremely rare. We herein report a case of total paraplegia caused by a giant intradural herniation of a lumbar disk at the L3-L4 level after total hip arthroplasty for coxarthrosis. The patient had no preoperative neurologic abnormalities. Intraoperative anesthetic management involved combined spinal-epidural anesthesia at the L3-L4 level with continuous intravenous propofol administration. Postoperatively, the patient complained of numbness and total paraplegia of the lower extremities. Magnetic resonance imaging showed a giant herniation of a lumbar disk compressing the spinal cord at the L3-L4 level. The intradural herniation was surgically treated, and the patient's symptoms completely resolved.
硬膜外或脊髓麻醉后出现完全性截瘫极为罕见。我们在此报告一例全髋关节置换术后因L3 - L4水平巨大腰椎间盘硬膜内疝导致完全性截瘫的病例。该患者术前无神经功能异常。术中麻醉管理采用L3 - L4水平腰麻 - 硬膜外联合麻醉并持续静脉输注丙泊酚。术后，患者主诉下肢麻木及完全性截瘫。磁共振成像显示L3 - L4水平巨大腰椎间盘疝压迫脊髓。对硬膜内疝进行了手术治疗，患者症状完全缓解。
