Taniguchi Ryota, Kawano Osamu, Maeda Takeshi, Nakajima Yasuharu, Morishita Yuichiro
Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan.
Department of Orthopedic Surgery, Kyushuu University, Fukuoka, Japan.
Case Rep Orthop. 2021 Dec 24;2021:5546530. doi: 10.1155/2021/5546530. eCollection 2021.
We report two cases of iatrogenic deterioration of lumbar foraminal disc herniations following lumbar disc injections. . Complications associated with discography were reported. However, only a few reports have thus far referred to the iatrogenic deterioration of lumbar foraminal disc herniations.
60-year-old and 74-year-old men were treated with MR images of L4-5 foraminal disc herniations without fragment in the spinal canal. The patients underwent discography and disc block for its diagnosis and treatment. After disc injections, both patients complained of deterioration of L4 radiculopathy.
On disco-CT or reexamined MR images after disc injections, herniated fragment was migrated from neural foramen to cranial central spinal canal with was not shown in previous MR images. The herniated fragments were extirpated by means of osteoplastic laminoplasty or transforaminal lumbar interbody fusion with facetectomy. The herniated fragments were migrated from neural foramen to cranial central spinal canal.
The injection of liquid medicine into the nucleus led the intradiscal pressure increased, and the disc fragment might prolapsed through the raptured region of annulus fibrosus and migrated to cranial central spinal canal by anatomical reason. The disc injection may have a risk for deterioration of foraminal disc herniation. Our report is instructive for the management of discography for the diagnosis of foraminal disc herniations.
我们报告两例腰椎间盘注射后医源性腰椎椎间孔型椎间盘突出症恶化的病例。已有关于椎间盘造影相关并发症的报道。然而，迄今为止，仅有少数报告提及医源性腰椎椎间孔型椎间盘突出症的恶化情况。
两名男性患者，年龄分别为60岁和74岁，均接受了L4 - 5椎间孔型椎间盘突出症的磁共振成像检查，椎管内无碎片。患者接受了椎间盘造影和椎间盘阻滞以进行诊断和治疗。椎间盘注射后，两名患者均主诉L4神经根病恶化。
椎间盘注射后的椎间盘CT或复查磁共振成像显示，突出碎片从神经孔迁移至椎管中央的头侧，而之前的磁共振成像未显示此情况。通过骨成形性椎板成形术或经椎间孔腰椎椎体间融合术加小关节切除术摘除了突出碎片。突出碎片从神经孔迁移至椎管中央的头侧。
向髓核内注射液体药物导致椎间盘内压力升高，椎间盘碎片可能通过纤维环破裂区域脱垂，并因解剖学原因迁移至椎管中央的头侧。椎间盘注射可能存在椎间孔型椎间盘突出症恶化的风险。我们的报告对椎间孔型椎间盘突出症诊断的椎间盘造影管理具有指导意义。
