Mallepally Abhinandan Reddy, Marathe Nandan, Sharma Jeevan Kumar, Mohaptra Bibhudendu, Das Kalidutta
Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India.
Int J Neurosci. 2023 May;133(5):567-573. doi: 10.1080/00207454.2021.1938034. Epub 2021 Jul 15.
Intraspinal synovial cysts occurrence causing spinal canal occlusion are mostly seen in mobile segments of the spine (lumbar and cervical). An appearance of the cyst in thoracic spine is a relatively rare occurrence. We present an interesting case of 'double crush' caused by Lumbar canal stenosis with a mid-dorsal Facet cyst.
A 67-year-old woman presented with complaints of back pain with neurogenic claudication with significant loss of touch sensation and motor power of MRC grade 3/5 in lower extremities bilaterally. However, patient was hyperreflexic with Babinski sign positive. She was unable to perform tandem walking test and complained of instability. MRI of lumbar spine revealed lumbar canal stenosis. However, in view of the UMN signs, an MRI of the dorsal spine was done. It revealed an extradural, well-delineated lesion along the dorsal aspect of spine at T6-7 level. Thus the patient had a 'double crush' due to the FC along with lumbar canal stenosis.
Two teams simultaneously operated the 2 pathologies and T6-7 laminectomy along with left sided TLIF at L4-5 level was performed. Presently she is asymptomatic for back pain, claudication distance has improved to 800 m.
Our case reiterates the importance of thorough clinical examination to avoid missing a diagnosis. Our case is the first in literature to report a 'double crush' due to a proximal dorsal FC and distal LCS. Both the pathologies were tackled in a single setting by two operating teams with a good functional outcome.
引起椎管阻塞的脊髓内滑膜囊肿大多见于脊柱的活动节段（腰椎和颈椎）。胸椎出现囊肿相对少见。我们报告一例有趣的由腰椎管狭窄合并胸中段小关节囊肿导致的“双重压迫”病例。
一名67岁女性，主诉背痛伴神经源性间歇性跛行，双下肢触觉明显减退，肌力为MRC 3/5级。然而，患者腱反射亢进，巴宾斯基征阳性。她无法进行串联行走试验，并主诉行走不稳。腰椎MRI显示腰椎管狭窄。鉴于存在上运动神经元体征，遂行胸椎MRI检查。结果显示在T6 - 7水平脊柱背侧有一个硬膜外界限清晰的病变。因此，该患者因小关节囊肿合并腰椎管狭窄而出现“双重压迫”。
两个手术团队同时对这两种病变进行手术，实施了T6 - 7椎板切除术以及L4 - 5节段左侧经椎间孔腰椎椎体间融合术。目前她背痛症状消失，间歇性跛行距离改善至8oom。
我们的病例再次强调了全面临床检查以避免漏诊的重要性。我们的病例是文献中首例报告由近端胸段小关节囊肿和远端腰椎管狭窄导致的“双重压迫”。两个手术团队在一次手术中处理了这两种病变，取得了良好的功能预后。
