Bamba Yohei, Fukunaga Takanori, Umegaki Masao, Tsuchida Yasuaki, Sasaki Manabu
Department of Neurosurgery and Spine Surgery, Iseikai Hospital, Osaka, Osaka, Japan.
Department of Neurosurgery, Suita Municipal Hospital, Suita, Osaka, Japan.
NMC Case Rep J. 2022 Oct 21;9:365-369. doi: 10.2176/jns-nmc.2022-0143. eCollection 2022.
Syringomyelia is often associated with Chiari malformation, trauma, infection, and spinal cord tumor. Although they are relatively rare diseases, arachnoid cysts and its related pathology, "arachnoid web" can sometimes lead to syrinx formation at the thoracic vertebral level. However, syrinx formation caused by degenerative spinal disorders, particularly at the thoracic vertebral levels, has rarely been reported. Herein, we present a case of syringomyelia with thoracic ossified yellow ligament (OYL) in a 79-year-old man, who underwent initial posterior decompression followed by arachnoid web removal. Posterior decompression via laminectomy of thoracic vertebra 2 and removal of the OYL improved the syrinx partially, but dorsal indentation of the spinal cord and a remnant syrinx were observed in post-operative magnetic resonance images, subsequent to the second surgery's successful removal of the arachnoid web, which had dorsally compressed the spinal cord. After the second operation, the syrinx shrunk further, and the patient could walk independently at 5 months after the operations. In our case, both the OYL and arachnoid web were responsible for syrinx formation. Therefore, the coincidence of degenerative vertebral diseases with a syrinx might indicate the coexistence of an underlying lesion. Furthermore, the arachnoid web in this case might have formed due to the denaturation of the arachnoid cyst triggered by the OYL.
脊髓空洞症常与 Chiari 畸形、创伤、感染及脊髓肿瘤相关。虽然它们是相对罕见的疾病，但蛛网膜囊肿及其相关病变“蛛网膜网”有时可导致胸椎水平的空洞形成。然而，由退行性脊柱疾病引起的空洞形成，尤其是在胸椎水平，鲜有报道。在此，我们报告一例 79 岁男性患有胸椎黄韧带骨化（OYL）的脊髓空洞症病例，该患者首先接受了后路减压，随后进行了蛛网膜网切除术。通过第 2 胸椎椎板切除术进行后路减压并切除 OYL 使空洞部分改善，但术后磁共振成像显示脊髓背侧有压迹且存在残留空洞，在第二次手术成功切除背侧压迫脊髓的蛛网膜网后，情况得到改善。第二次手术后，空洞进一步缩小，患者在术后 5 个月能够独立行走。在我们的病例中，OYL 和蛛网膜网均与空洞形成有关。因此，退行性脊柱疾病与空洞的同时存在可能提示潜在病变的共存。此外，本例中的蛛网膜网可能是由 OYL 引发的蛛网膜囊肿变性形成的。
