Rigal Julien, Quarto Emanuele, Boue Lisa, Balabaud Laurent, Thompson Wendy, Cloché Thibault, Bourret Stephane, Le Huec Jean Charles
Vertebra, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France.
Neurospine. 2022 Jun;19(2):472-477. doi: 10.14245/ns.2143232.616. Epub 2022 May 17.
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronic relapsing disease of unknown aetiology. The diagnosis of this disease is still very complicated. The treatment is medical but, in some cases, a surgical decompression might be required. In rare cases it develops a radicular hypertrophy that can cause a cervical myelopathy; this pathology should be put in differential diagnosis with neurofibromatosis 1 and CharcotMarie-Tooth (CMT) syndromes. The cases of CIDP cervical myelopathy reported in the literature are rare and even more rarely a surgical decompression was described. Here we report a first and unique case of CIDP cervical myelopathy treated with an open-door laminoplasty technique with 10-year postoperative follow-up (FU). The surgical decompression revealed to be effective in stopping the progression of myelopathy without destabilizing the spine. The patient that before surgery presented a severe tetraparesis could return to walk and gain back his self-care autonomy. At 10-year FU he did not complain of neck pain and did not develop a cervical kyphosis. In case of cervical myelopathy caused by radicular hypertrophy, CIDP should be kept in mind in the differential diagnosis and an open-door laminoplasty is indicated to stop myelopathy progression.
慢性炎症性脱髓鞘性多发性神经根神经病(CIDP)是一种病因不明的慢性复发性疾病。该疾病的诊断仍然非常复杂。治疗以药物为主,但在某些情况下可能需要进行手术减压。在罕见情况下,它会发展为神经根肥大,可导致颈髓病;这种病变应与1型神经纤维瘤病和夏科-马里-图斯(CMT)综合征进行鉴别诊断。文献中报道的CIDP颈髓病病例很少,描述手术减压的情况更为罕见。在此,我们报告首例且唯一一例采用开门式椎板成形术治疗的CIDP颈髓病病例,并进行了术后10年的随访。手术减压显示可有效阻止脊髓病进展,且不会使脊柱失稳。术前出现严重四肢瘫的患者能够恢复行走并重新获得自我护理能力。在10年随访时,他没有颈部疼痛的主诉,也没有出现颈椎后凸。对于由神经根肥大引起的颈髓病,在鉴别诊断中应考虑CIDP,并且建议采用开门式椎板成形术来阻止脊髓病进展。