Lim Dong-Ju, Lee Joon-Ho
Department of Orthopaedic Surgery, Seoul Spine Institute, Sanggyepaik Hospital, College of Medicine, Inje University, Republic of Korea.
Department of Orthopaedic Surgery, Seoul Spine Institute, Sanggyepaik Hospital, College of Medicine, Inje University, Republic of Korea.
Int J Surg Case Rep. 2020;67:21-24. doi: 10.1016/j.ijscr.2020.01.017. Epub 2020 Jan 23.
Intradural foreign bodies have been reported to be associated with disc material, tumors, and bullets following spinal gunshot injuries. In this report, we describe a case of non-union with minor trauma that caused interbody bone graft material to migrate into the intrathecal area in a patient with RA.
We present the case of a 65-year-old woman visited an outpatient clinic of our hospital after experiencing progressive lower extremity weakness, and voiding and defecation difficulty after fell down several times in the past. She had a history of two spinal decompression with fixation surgeries due to spinal stenosis with a herniated intervertebral disc. She was prescribed steroids and methotrexate for the RA. The results of MRI and CT demonstrated an intradural bone graft material migration with cauda equina syndrome after revision lumbar stenosis surgery. Calcified material protruded to the intracanal area and compressed the cauda equina fiber. After the removal of fragments operation, she recovered from cauda equina symptoms. A follow-up examination two years postoperatively revealed clinical resolution of cauda equina symptoms and a return to partial walking with a cane.
The patient had a minor or major trauma, such as a fall, after the revision surgery. After that trauma, the patient presented with some dural injury, kyphotic position, or non-union state causing the dural penetration of the interbody fusion material.
The first report describing displaced PLIF graft material that penetrated the dural sac and caused cauda equina symptoms in a patient with RA. Establishing strategies to minimize these complications is indicated when treating degenerative lumbar spine conditions in patients with RA.
硬膜内异物据报道与椎间盘物质、肿瘤以及脊柱枪伤后的子弹有关。在本报告中，我们描述了一例类风湿关节炎（RA）患者因轻微创伤导致椎间骨移植材料迁移至鞘内区域并出现骨不连的病例。
我们报告一例65岁女性患者，在过去几次跌倒后出现进行性下肢无力、排尿和排便困难，随后到我院门诊就诊。她有因腰椎管狭窄伴椎间盘突出症进行两次脊柱减压固定手术的病史。她因类风湿关节炎接受类固醇和甲氨蝶呤治疗。MRI和CT结果显示翻修腰椎管狭窄手术后硬膜内骨移植材料迁移并伴有马尾综合征。钙化物质突出至椎管内区域并压迫马尾神经纤维。在进行碎骨片清除手术后，她的马尾神经症状得到缓解。术后两年的随访检查显示马尾神经症状临床缓解，患者可借助拐杖部分行走。
患者在翻修手术后遭受了轻微或严重创伤，如跌倒。创伤后，患者出现了一些硬膜损伤、后凸畸形或骨不连状态，导致椎间融合材料穿透硬膜。
首次报道了类风湿关节炎患者中移位的后路腰椎椎间融合（PLIF）移植材料穿透硬膜囊并导致马尾神经症状的病例。在治疗类风湿关节炎患者的退行性腰椎疾病时，需要制定策略以尽量减少这些并发症。
