Stevens E, Williams B, Kock N, Kitching M, Simpson M P
Department of Anaesthetics East and North Hertfordshire NHS Trust Stevenage United Kingdom.
Department of Neurology East and North Hertfordshire NHS Trust Stevenage United Kingdom.
Anaesth Rep. 2019 Mar 11;7(1):7-10. doi: 10.1002/anr3.12001. eCollection 2019 Jan-Jun.
This report presents an obstetric patient with no significant past medical history who underwent spinal anaesthesia for a category-three caesarean section. On examination, she had asymmetrical scapular alignment and a mild scoliosis of the lumbar spine with no functional limitation. Postoperatively the patient developed neuropathic pain symptoms in the right leg which failed to resolve with conventional analgesia. Cervical and lumbar spine magnetic resonance imaging was performed resulting in a diagnosis of a low-lying tethered spinal cord terminating at the level of L5 and congenital fusion of the C7/T1 vertebrae. A tethered spinal cord is a rare condition, which in this case had been completely asymptomatic. However, we suggest that the patient displayed musculoskeletal signs not previously widely reported, which could have indicated the presence of a potential underlying neural tube defect. Based on the imaging findings and the presence of Sprengel's deformity, the patient was diagnosed with Klippel-Feil syndrome.
本报告介绍了一位既往无重大病史的产科患者，其因三级剖宫产接受了脊髓麻醉。检查时，她存在肩胛不对称排列以及轻度腰椎侧弯，但无功能受限。术后，患者右腿出现神经性疼痛症状，常规镇痛治疗无效。进行了颈椎和腰椎磁共振成像检查，结果诊断为低位脊髓栓系终止于L5水平以及C7/T1椎体先天性融合。脊髓栓系是一种罕见病症，在本病例中此前完全无症状。然而，我们认为该患者表现出了此前未广泛报道的肌肉骨骼体征，这可能提示存在潜在的神经管缺陷。基于影像学检查结果及先天性高肩胛症畸形的存在，该患者被诊断为克-费综合征。
