Surgical Services, VA Palo Alto Health Care System, Palo Alto, CA, USA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
Spinal Cord Ser Cases. 2020 May 13;6(1):41. doi: 10.1038/s41394-020-0286-5.
Patients with complete spinal cord injury (SCI) may develop concurrent sequalae that interact and share symptoms; thus, a careful approach to diagnosis and management of new symptoms is crucial.
A patient with prior T4 complete SCI presented with progressive autonomic nervous system (ANS) dysfunction. The initial differential diagnosis included syringomyelia and lumbar Charcot arthropathy. He had comorbid heterotopic ossification (HO) of the left hip. Surprisingly, his autonomic symptoms resolved following resection of the HO. In hindsight, loss of motion through the hip caused by HO may have led to hinging through a previously asymptomatic lumbar Charcot joint, causing dysautonomia.
ANS dysfunction is a disabling sequela of complete SCI and has a broad differential diagnosis. Hip immobility may be an indirect and overlooked cause due to the mechanical relationship between the hip and the lumbar spine.
完全性脊髓损伤（SCI）患者可能会并发相互作用并具有共同症状的后遗症；因此，仔细诊断和管理新症状至关重要。
一名 T4 完全性 SCI 患者出现进行性自主神经系统（ANS）功能障碍。最初的鉴别诊断包括脊髓空洞症和腰椎夏科氏关节炎。他还患有左侧髋关节异位骨化（HO）。令人惊讶的是，HO 的切除后他的自主症状得到了缓解。事后看来，HO 导致髋关节运动丧失可能导致以前无症状的腰椎夏科关节铰链，从而导致自主神经功能紊乱。
ANS 功能障碍是完全性 SCI 的一种致残后遗症，具有广泛的鉴别诊断。髋关节活动受限可能是由于髋关节和腰椎之间的机械关系而被忽视的间接原因。
