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慢性炎症性脱髓鞘性多发性神经根神经病导致压迫性颈髓病的原手术治疗及长期随访:文献综述

Original Surgical Treatment and Long-term Follow-up for Chronic Inflammatory Demyelinating Polyradiculoneuropathy Causing a Compressive Cervical Myelopathy: Review of the Literature.

作者信息

Rigal Julien, Quarto Emanuele, Boue Lisa, Balabaud Laurent, Thompson Wendy, Cloché Thibault, Bourret Stephane, Le Huec Jean Charles

机构信息

Vertebra, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France.

出版信息

Neurospine. 2022 Jun;19(2):472-477. doi: 10.14245/ns.2143232.616. Epub 2022 May 17.

Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0783/9260558/41c86651c971/ns-2143232-616f1.jpg

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