Brogna Christian, Lavrador José Pedro, Patel Sabina, Vergani Francesco, Bassi Sanjeev, Grahovac Gordan, Bhangoo Ranjeev, Ashkan Keyoumars
Neurosurgical Department, King's College Hospital Foundation Trust, London, United Kingdom.
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Surg Neurol Int. 2018 Jun 18;9:119. doi: 10.4103/sni.sni_29_18. eCollection 2018.
Intradural disc herniations (IDH) are rare, particularly in the cervical spine, where they account for less than 5% of all discs. Adhesions between the ossified/calcified posterior longitudinal ligament (OPLL), dura, and ossified/calcified disc herniations increase the complexity of resecting these cervical lesions.
A 42-year-old male presented with a rapidly progressive cervical myelopathy over a 2-month period. This was attributed to an ossified/calcified intradural cervical disc herniation in conjunction with OPLL. The anterior cervical discectomy and fusion (ACDF) resulted in a dural defect but there was no cerebrospinal fluid (CSF) fistula as the arachnoid membrane remained intact. Had there been a CSF leak, it would have warranted both wound-peritoneal (WP) and lumbo-peritoneal shunts (LP). The surgeons should have anticipated that a CSF leak would likely occur prior to performing the ACDF, and should have prophylactically prepared and draped the abdomen for a potential WP, followed by a LP shunt. Three months postoperatively, the patient's proprioceptive deficit improved, and he almost completely recovered motor function.
Performing an ACDF for resection of an intradural calcified/ossified disc with OPLL often results in both a dural defect and CSF fistula. As the arachnoid membrane rarely remains intact, the spine surgeon should be prepared to immediately perform both a WP shunt, and subsequently, an LP. In this case, following an ACDF, resection of an intradural ossified disc with OPLL resulted in an isolated dural defect without a CSF fistula and did not require no dural repair or shunting procedures.
硬膜内椎间盘突出症（IDH）较为罕见，尤其是在颈椎，其在所有椎间盘病变中占比不到5%。骨化/钙化的后纵韧带（OPLL）、硬脑膜和骨化/钙化的椎间盘突出之间的粘连增加了切除这些颈椎病变的复杂性。
一名42岁男性在2个月内出现快速进展的颈椎脊髓病。这归因于骨化/钙化的硬膜内颈椎间盘突出合并OPLL。前路颈椎间盘切除融合术（ACDF）导致了硬脑膜缺损，但由于蛛网膜保持完整，未出现脑脊液（CSF）瘘。如果出现CSF漏，则需要进行伤口-腹膜（WP）分流术和腰-腹膜分流术（LP）。外科医生在进行ACDF之前应预料到可能会发生CSF漏，并应为潜在的WP预防性地准备和铺巾腹部，随后进行LP分流术。术后3个月，患者本体感觉障碍改善，运动功能几乎完全恢复。
采用ACDF切除伴有OPLL的硬膜内钙化/骨化椎间盘通常会导致硬脑膜缺损和CSF瘘。由于蛛网膜很少保持完整，脊柱外科医生应准备好立即进行WP分流术，随后进行LP分流术。在本病例中，ACDF术后，切除伴有OPLL的硬膜内骨化椎间盘导致了孤立的硬脑膜缺损但无CSF瘘，且无需进行硬脑膜修复或分流手术。
