Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
Department of Orthopaedic Surgery, Kansai Medical University, 2-3-1 Shinmachi, Hirakata City, Osaka, 573-1191, Japan.
BMC Musculoskelet Disord. 2020 May 14;21(1):302. doi: 10.1186/s12891-020-03299-x.
Neurogenic origin intermittent claudication is typically caused by lumbar spinal canal stenosis. However, there are few reports of intermittent claudication caused by cervical spinal cord compression.
We present the case of a 75-year-old woman who presented with intermittent claudication. She had a history of lumbar spinal fusion surgery, but there was no sign of lumbar spinal stenosis. She also reported bilateral thigh pain on cervical extension. Electromyogram (EMG), posture-induced test, myelogram, and post-myelogram dynamic computed tomography (CT) were performed. Myelography and post-myelogram dynamic CT in the cervical extension position showed narrowing of the subarachnoid space; the patient reported pain in the front of the both thigh during the procedure. We performed an electromyogram (EMG), which implied neurogenic changes below the C5 level. Based on these results, we diagnosed cervical spinal cord compression and underwent laminoplasty at C4-6 including dome-like laminectomy, which significantly relieved the thigh pain and enabled her to walk for 40 minutes.
In this case, funicular pain presented as leg pain, but was resolved by the decompression of the cervical spinal cord. Funicular pain has various characteristics without any upper extreme symptom. This often leads to errors in diagnosis and treatment. We avoid the misdiagnosis by evaluating post-myelogram dynamic CT compared between flexion and extension. In cases of intermittent claudication, clinicians should keep in mind that cervical cord compression could be a potential cause.
神经源性间歇性跛行通常由腰椎椎管狭窄引起。然而，由颈椎脊髓压迫引起的间歇性跛行的报告较少。
我们报告了一例 75 岁女性间歇性跛行的病例。她曾有腰椎融合手术史，但无腰椎狭窄的迹象。她还报告颈椎伸展时双侧大腿疼痛。进行了肌电图（EMG）、姿势诱导试验、脊髓造影和脊髓造影后动态 CT（CT）检查。颈椎伸展位脊髓造影和脊髓造影后动态 CT 显示蛛网膜下腔狭窄；患者在检查过程中报告大腿前部疼痛。我们进行了肌电图（EMG）检查，提示 C5 以下存在神经性改变。根据这些结果，我们诊断为颈椎脊髓压迫，并在 C4-6 进行了椎板成形术，包括穹窿样椎板切除术，这显著缓解了大腿疼痛，使她能够行走 40 分钟。
在本例中，神经根性疼痛表现为腿部疼痛，但通过颈椎脊髓减压得到缓解。神经根性疼痛具有各种特征，没有任何上极端症状。这常常导致误诊和治疗错误。我们通过评估屈伸位脊髓造影后动态 CT 来避免误诊。对于间歇性跛行患者，临床医生应记住颈椎压迫可能是潜在的原因。
