Nicholas J J, Christy W C
Arch Phys Med Rehabil. 1986 Sep;67(9):598-600.
In the absence of physical findings, pain in the low back, cervical or thoracic spine, or the extremities presents a diagnostic problem. On occasion the pain is present or made worse only when the patient lies down. We have attended four patients with underlying extradural tumors of the spinal canal. A 75-year-old woman with chronic back pain was treated for multiple myeloma with intravenous dexamethasone and 400 rads of x-ray irradiation to the lumbar spine and experienced marked pain relief in 24 hours. A 76-year-old woman with neck pain had complete pain relief after a vascular, calcified meningioma was removed surgically from under the 2nd and 3rd cervical nerve roots. A 38-year-old male with constant pain in the lumbar area and right leg and foot experienced marked relief from pain after a neurolemmoma of the cauda equina was surgically removed. A 57-year-old woman with knee pain became pain free 24 hours after radiation therapy to an enlarged nodular cauda equina. These four cases illustrate a diagnostic clue rarely mentioned in the literature.
在没有体格检查发现的情况下，下背部、颈椎或胸椎以及四肢的疼痛会带来诊断难题。有时，疼痛仅在患者躺下时出现或加重。我们诊治了4例患有椎管内硬膜外肿瘤的患者。一名75岁慢性背痛女性因多发性骨髓瘤接受了静脉注射地塞米松治疗，并对腰椎进行了400拉德的X线照射，24小时内疼痛明显缓解。一名76岁颈部疼痛女性在第2和第3颈神经根下方手术切除血管钙化性脑膜瘤后疼痛完全缓解。一名38岁男性腰部及右腿和足部持续疼痛，在手术切除马尾神经鞘瘤后疼痛明显减轻。一名57岁膝盖疼痛女性在对肿大的结节状马尾进行放射治疗24小时后疼痛消失。这4例病例说明了一个在文献中很少提及的诊断线索。
