Hirai Takashi, Yoshii Toshitaka, Tanimoto Takahiro, Ushio Shuta, Sasaki Shinichi, Inose Hiroyuki, Yuasa Masato, Okawa Atsushi
Department of Orthopedic Surgery, Tokyo Medical and Dental University.
Department of Orthopedic Surgery, Nerima General Hospital, Tokyo, Japan.
Medicine (Baltimore). 2019 Oct;98(41):e17344. doi: 10.1097/MD.0000000000017344.
The meningovertebral ligaments are a group of tissues that connect the dura and the vertebral bone. Abnormal fibrous ligaments in the canal space, which are essentially different from these ligaments, have been identified and their presence very rarely results in spinal disorder.
A 20-year-old Mongolian woman had developed persistent headache at 15 years of age. She then became unable to run fast when she was 19 years old and had progressively declining ability to move. She complained of back pain and unstable gait 6 months prior to presentation. Physical examination revealed exaggerated deep tendon reflexes in the lower extremities and decreased proximal leg muscle strength bilaterally.
Magnetic resonance imaging (MRI) revealed abnormal bands compressing the spinal cord at the T10/11 level, with large epidural lipomatosis dorsal to the dural tube.
To decompress the cord, posterior laminectomy for T3-L3 and removal of the heterotopic ligaments were performed with T8-L1 posterior fusion.
Sufficient decompression of the cord was noted on postoperative MRI at the affected segments. The patient could subsequently walk without a cane and headache resolved immediately after the operation.
The presence of an aberrant epidural band is a rare pathologic state that often coexists with a surrounding lipomatosis and can lead to spinal cord compression. Removal of the band is a promising treatment for myelopathy caused by the compressive lesion.
脑脊膜-椎体韧带是连接硬脑膜和椎骨的一组组织。椎管内异常的纤维韧带与这些韧带本质不同，已被识别，其存在极少导致脊柱疾病。
一名20岁的蒙古族女性15岁时出现持续性头痛。19岁时她开始无法快跑，且运动能力逐渐下降。就诊前6个月，她主诉背痛和步态不稳。体格检查发现双下肢深腱反射亢进，双侧近端腿部肌肉力量减弱。
磁共振成像（MRI）显示在T10/11水平有异常束带压迫脊髓，硬脊膜管背侧有大量硬膜外脂肪增多症。
为解除脊髓压迫，进行了T3-L3后路椎板切除术并切除异位韧带，同时进行了T8-L1后路融合术。
术后MRI显示受累节段脊髓得到充分减压。患者随后能够不用拐杖行走，术后头痛立即缓解。
硬膜外异常束带的存在是一种罕见的病理状态，常与周围脂肪增多症并存，可导致脊髓压迫。切除束带是治疗由压迫性病变引起的脊髓病的一种有前景的治疗方法。
