Department of Trauma & Orthopaedic Surgery, Royal Shrewsbury Hospital, The Shrewsbury & Telford Hospital NHS Trust, Shrewsbury, UK.
Deparment of Trauma & Orthopaedic Surgery, Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK.
BMJ Case Rep. 2020 Dec 17;13(12):e237779. doi: 10.1136/bcr-2020-237779.
A 67-year-old man presented to his general practitioner with intermittent episodes of unilateral sciatica over a 2-month period for which he was referred for an outpatient MRI of his spine. This evidenced a significant lumbar vertebral mass that showed tight canal stenosis and compression of the cauda equina. The patient was sent to the emergency department for management by orthopaedic surgeons. He was mobilising independently, pain free on arrival and without neurological deficit on assessment. Clinically, this patient presented with no red flag symptoms of cauda equina syndrome or reason to suspect malignancy. In these circumstances, National Institute for Health and Care Excellence guidelines do not support radiological investigation of the spine outside of specialist services. However, in this case, investigation helped deliver urgent care for cancer that otherwise may have been delayed. This leads to the question, do the current guidelines meet clinical requirements?
一位 67 岁男性因 2 个月来间歇性单侧坐骨神经痛就诊于全科医生，随后转诊行脊柱门诊 MRI 检查。结果显示明显的腰椎肿块，伴有椎管狭窄和马尾神经受压。患者被送往急诊室接受骨科医生的治疗。他在到达时可以独立移动，无痛且无神经功能缺损的迹象。从临床角度来看，该患者没有马尾综合征的红旗症状，也没有理由怀疑恶性肿瘤。在这种情况下，英国国家卫生与临床优化研究所（NICE）指南不支持在专科服务之外对脊柱进行影像学检查。然而，在这种情况下，检查有助于为癌症提供紧急治疗，否则可能会被延误。这就引出了一个问题，现行指南是否符合临床要求？
