Hirasawa Rui, Itabashi Takashi, Kita Tsuneji, Mannoji Chikato
Department of Orthopedic Surgery, Japanese Red Cross Narita Hospital, 90-1, Iidacho, Narita-shi, Chiba 286-8523, Japan.
Case Rep Orthop. 2020 Mar 23;2020:3439403. doi: 10.1155/2020/3439403. eCollection 2020.
We encountered two cases of cervical disc herniation, wherein cerebrospinal fluid collection in the ventral epidural space between the cervical spine and the thoracic spine was noted. The patients, two women aged 71 and 43 years, were diagnosed with cervical disc herniation and underwent anterior cervical discectomy and fusion. Unexpected cerebrospinal fluid leakage was observed prior to exposure of the dura mater. Notably, the dura mater was intact following the removal of the herniated disc in both cases. No cerebrospinal fluid leakage symptoms were observed, and relief from the neurological symptoms related to the cervical disc herniation was observed in both cases following the surgery. Findings of preoperative magnetic resonance imaging and computed tomography myelography were carefully reviewed, retrospectively. Both patients presented with similar features including expansion of cerebrospinal fluid collection in the ventral epidural space between the cervical spine and the thoracic spine. These observed features were similar to those of superficial siderosis, which is a form of duropathy-a disease caused by dural defects. Therefore, the patients in this case study might have a subclinical duropathy with associated cervical disc herniation.
我们遇到了两例颈椎间盘突出症患者,其中发现颈椎与胸椎之间的腹侧硬膜外间隙有脑脊液聚集。这两名患者均为女性,年龄分别为71岁和43岁,被诊断为颈椎间盘突出症,并接受了颈椎前路椎间盘切除融合术。在硬脑膜暴露之前观察到意外的脑脊液漏。值得注意的是,在两例病例中,切除突出椎间盘后硬脑膜均保持完整。未观察到脑脊液漏症状,且两例患者术后均观察到与颈椎间盘突出症相关的神经症状有所缓解。回顾性地仔细复查了术前磁共振成像和计算机断层扫描脊髓造影的结果。两名患者均表现出相似的特征,包括颈椎与胸椎之间腹侧硬膜外间隙脑脊液聚集扩大。这些观察到的特征与浅表性铁沉积症相似,浅表性铁沉积症是一种硬脑膜病——由硬脑膜缺损引起的疾病。因此,本病例研究中的患者可能患有伴有颈椎间盘突出症的亚临床硬脑膜病。