Mataki Kentaro, Koda Masao, Shibao Yosuke, Kumagai Hiroshi, Nagashima Katsuya, Miura Kousei, Noguchi Hiroshi, Funayama Toru, Abe Tetsuya, Yamazaki Masashi
Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
Case Rep Orthop. 2020 Jan 13;2020:2425637. doi: 10.1155/2020/2425637. eCollection 2020.
Several reports have described the coexistence of spina bifida occulta (SBO) and spondylolysis, but the majority of defects occur at L5. No report has described the coexistence of SBO and spondylolysis at the thoracolumbar junction. We report a case of SBO with spondylolysis at L1, presenting cauda equine syndrome. A 37-year-old man presented with a gait disorder as a result of bilateral motor weakness of the lower extremities. A plain radiograph showed local kyphosis at L1-2 as a result of severe degenerative change and wedging of the vertebral body at L1. Magnetic resonance imaging (MRI) revealed degenerative disc changes and severe canal stenosis at L1-2. Computed tomography (CT) revealed SBO and spondylolysis at L1. He was diagnosed with cauda equina syndrome related to SBO and spondylolysis at L1. Posterior interbody fusion and decompression at L1-2 were performed. After surgery, his muscle power recovered to normal strength. The possible mechanisms in this case are the strain on anterior elements as a result of disruption of the posterior elements due to SBO and spondylolysis. The coexistence of SBO and spondylolysis at the thoracolumbar junction might induce at-risk status of increased strain to the anterior elements that may cause cauda equina syndrome.
有几份报告描述了隐性脊柱裂（SBO）和椎弓根峡部裂的共存情况，但大多数缺陷发生在L5。尚无报告描述胸腰段交界处SBO与椎弓根峡部裂的共存情况。我们报告一例L1处SBO合并椎弓根峡部裂并出现马尾综合征的病例。一名37岁男性因双下肢运动无力出现步态障碍。X线平片显示L1-2处局部后凸，这是由于严重的退行性变和L1椎体楔形变所致。磁共振成像（MRI）显示L1-2处椎间盘退变和严重的椎管狭窄。计算机断层扫描（CT）显示L1处存在SBO和椎弓根峡部裂。他被诊断为与L1处SBO和椎弓根峡部裂相关的马尾综合征。行L1-2后路椎间融合及减压术。术后，他的肌力恢复至正常强度。该病例可能的机制是由于SBO和椎弓根峡部裂导致后柱破坏，进而引起前柱的应变。胸腰段交界处SBO与椎弓根峡部裂的共存可能会使前柱承受增加的应变，从而导致马尾综合征的风险状态。
