椎间盘造影有助于腰椎间盘碎片后硬膜外迁移的明确诊断：病例报告及文献综述
Discography aids definitive diagnosis of posterior epidural migration of lumbar disc fragments: case report and literature review.
作者信息
Takano Morito, Hikata Tomohiro, Nishimura Soraya, Kamata Michihiro
机构信息
Department of Orthopaedic Surgery, Spine Center, Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan.
Department of Orthopaedic Surgery, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8521, Japan.
出版信息
BMC Musculoskelet Disord. 2017 Apr 11;18(1):151. doi: 10.1186/s12891-017-1516-2.
BACKGROUND
Posterior epidural migration of lumbar disc fragments (PEMLDF) is extremely rare. It is often confused with other posterior lesions and is usually diagnosed intraoperatively. We here describe the use of preoperative discography in the diagnosis of PEMLDF.
CASE PRESENTATION
A 78-year-old man presented with acute low back pain, gait disturbance, and paresthesia in both legs. Magnetic resonance imaging showed a mass located posteriorly and laterally to the left aspect of the dural sac at the L3 level. The initial diagnosis indicated PEMLDF, malignancy, spontaneous hematoma, or epidural abscess. L3/4 discography clearly showed leakage of the contrast medium into the posterior dural space, indicating PEMLDF. The lesion was identified intraoperatively as a herniated-disc fragment, consistent with the preoperative discography.
CONCLUSION
PEMDLF is difficult to diagnose preoperatively. Discography is useful for the definitive diagnosis of PEMDLF prior to surgery.
背景
腰椎间盘碎片硬膜外后移（PEMLDF）极为罕见。它常与其他后部病变相混淆，通常在手术中才能确诊。我们在此描述术前椎间盘造影在PEMLDF诊断中的应用。
病例介绍
一名78岁男性，出现急性腰痛、步态障碍和双下肢感觉异常。磁共振成像显示在L3水平硬脊膜囊左侧后方和外侧有一肿块。初步诊断提示为PEMLDF、恶性肿瘤、自发性血肿或硬膜外脓肿。L3/4椎间盘造影清晰显示造影剂漏入硬脊膜后间隙，提示PEMLDF。术中发现病变为椎间盘碎片突出，与术前椎间盘造影结果相符。
结论
PEMDLF术前难以诊断。椎间盘造影有助于在手术前明确诊断PEMDLF。
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