Pennington Zach, Jiang Bowen, Westbroek Erick M, Cottrill Ethan, Greenberg Benjamin, Gailloud Philippe, Wolinsky Jean-Paul, Lum Ying Wei, Theodore Nicholas
1Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
2Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas.
J Neurosurg Spine. 2020 Mar 20;33(1):114-119. doi: 10.3171/2020.1.SPINE191455. Print 2020 Jul 1.
Myelopathy selectively involving the lower extremities can occur secondary to spondylotic changes, tumor, vascular malformations, or thoracolumbar cord ischemia. Vascular causes of myelopathy are rarely described. An uncommon etiology within this category is diaphragmatic crus syndrome, in which compression of an intersegmental artery supplying the cord leads to myelopathy. The authors present the operative technique for treating this syndrome, describing their experience with 3 patients treated for acute-onset lower-extremity myelopathy secondary to hypoperfusion of the anterior spinal artery.
All patients had compression of a lumbar intersegmental artery supplying the cord; the compression was caused by the diaphragmatic crus. Compression of the intersegmental artery was probably producing the patients' symptoms by decreasing blood flow through the artery of Adamkiewicz, causing lumbosacral ischemia.
All patients underwent surgery to transect the offending diaphragmatic crus. Each patient experienced substantial symptom improvement, and 2 patients made a full neurological recovery before discharge.
Diaphragmatic crus syndrome is a rare or under-recognized cause of ischemic myelopathy. Patients present with episodic acute-on-chronic lower-extremity paraparesis, gait instability, and numbness. Angiography confirms compression of an intersegmental artery that gives rise to a dominant radiculomedullary artery. Transecting the offending diaphragmatic crus can produce complete resolution of neurological symptoms.
脊髓病选择性累及下肢可继发于脊柱退变、肿瘤、血管畸形或胸腰段脊髓缺血。脊髓病的血管病因鲜有描述。此类病因中一种不常见的是膈脚综合征，即供应脊髓的节段间动脉受压导致脊髓病。作者介绍了治疗该综合征的手术技术，并描述了他们治疗3例因脊髓前动脉灌注不足继发急性起病的下肢脊髓病患者的经验。
所有患者均存在供应脊髓的腰段节段间动脉受压；压迫由膈脚引起。节段间动脉受压可能通过减少通过Adamkiewicz动脉的血流导致腰骶部缺血，从而产生患者的症状。
所有患者均接受了切断致病膈脚的手术。每位患者的症状均有显著改善，2例患者在出院前神经功能完全恢复。
膈脚综合征是缺血性脊髓病的一种罕见或未被充分认识的病因。患者表现为发作性急性起病的慢性下肢轻瘫、步态不稳和麻木。血管造影证实供应主要神经根脊髓动脉的节段间动脉受压。切断致病膈脚可使神经症状完全缓解。
