Lee Wonho, Boudier-Revéret Mathieu, Kim Du Hwan, Chang Min Cheol
Department of Radiology, Topspine Hospital, Daegu 41931, Korea.
Department of Physical Medicine and Rehabilitation, Centre hospitalier de l'Université de Montréal, Montreal, H2W 1T8, Canada.
Diagnostics (Basel). 2020 Mar 27;10(4):185. doi: 10.3390/diagnostics10040185.
A 77-year-old woman having back pain due to an L2 vertebral body compression fracture took a lumbar spine magnetic resonance imaging (MRI). In MRI, in addition to the L2 vertebral body fracture, invagination of the small intestine into the intervertebral disc space at L5-S1 was found by chance. On a lateral lumbar spinal X-ray, the lordotic angle was markedly increased at the L5-S1 level. Additionally, the L5-S1 disc space had widened. These X-ray findings indicate the segmental instability at L5-S1. The spinal fusion operation on L3-4-5 seems to have resulted in overt mechanical loading on the inferior spinal segment (L5-S1). We think the instability damaged the anterior longitudinal ligament and caused a tear in the anterior portion of the annulus fibrosus. The defect in the L5-S1 intervertebral disc after the tear would have caused the vacuum, which is presumed to have pulled the patient's small intestine into the empty space within the L5-S1 intervertebral disc. Although intervertebral invagination of intra-abdominal structures is not common, clinicians should be aware of the possibility of this complication in patients who have spinal segmental instability.
一名因L2椎体压缩性骨折而背痛的77岁女性接受了腰椎磁共振成像（MRI）检查。在MRI检查中，偶然发现除了L2椎体骨折外，小肠向L5-S1椎间盘间隙内陷。在腰椎侧位X线片上，L5-S1水平的前凸角明显增大。此外，L5-S1椎间盘间隙增宽。这些X线表现提示L5-S1节段不稳定。L3-4-5的脊柱融合手术似乎导致了下脊柱节段（L5-S1）明显的机械负荷。我们认为这种不稳定损伤了前纵韧带，并导致纤维环前部撕裂。撕裂后L5-S1椎间盘的缺损会导致真空形成，据推测这将患者的小肠吸入L5-S1椎间盘内的空隙。虽然腹腔内结构向椎间盘内陷并不常见，但临床医生应意识到脊柱节段不稳定患者出现这种并发症的可能性。
