一名脊髓脊膜膨出修补术后并发腰椎管狭窄的老年患者出现神经功能衰退
Neurologic Decline in an Older Patient with Repaired Myelomeningocele Complicated with Lumbar Canal Stenosis.
作者信息
Matsuda Shingo, Yamaguchi Satoshi, Kajihara Yosuke, Takeda Masaaki, Kolakshyapati Manish, Kurisu Kaoru
机构信息
Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
出版信息
World Neurosurg. 2017 Jul;103:952.e1-952.e4. doi: 10.1016/j.wneu.2017.04.075. Epub 2017 Apr 20.
BACKGROUND
Tethered cord syndrome is a well-known complication after myelomeningocele (MMC) repair in childhood. However, late complications in adults with a repaired MMC are not well understood. In particular, the influence of a degenerative spinal deformity on a sustained tethered cord is still unclear.
CASE DESCRIPTION
A 63-year-old man with a repaired MMC exhibited a progressive gait disturbance and numbness in both lower limbs. Magnetic resonance imaging demonstrated that the tethered spinal cord was compressed by severe canal stenosis along the entire lumbar spine. After a multi-level lumbar decompression surgery, the patient recovered to baseline neurologic status.
CONCLUSION
In adults with a repaired MMC, lumbar canal stenosis should be investigated as a possible cause of late neurologic decline. Clinical manifestations may be complicated by the coexistence of both the original and subsequent neurologic disorders. Because these additional disorders result from compressive myelopathy, early surgical decompression is indicated to avoid irreversible spinal cord dysfunction.
背景
脊髓拴系综合征是儿童脊柱裂修补术后一种众所周知的并发症。然而，成人脊柱裂修补术后的晚期并发症尚未得到充分了解。特别是，退行性脊柱畸形对持续脊髓拴系的影响仍不清楚。
病例描述
一名63岁脊柱裂修补术后男性出现进行性步态障碍和双下肢麻木。磁共振成像显示，整个腰椎严重椎管狭窄压迫脊髓拴系。经过多级腰椎减压手术后，患者恢复到基线神经状态。
结论
对于脊柱裂修补术后的成人，应调查腰椎管狭窄是否为晚期神经功能衰退的可能原因。临床表现可能因原有和后续神经疾病并存而复杂化。由于这些额外疾病是由压迫性脊髓病引起的，因此建议早期手术减压以避免不可逆的脊髓功能障碍。
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