腰椎黄韧带血肿合并硬膜外血肿致马尾神经受压病例
Case of lumbar ligamentum flavum hematoma with epidural hematoma resulting in cauda equina compression.
作者信息
Hisamitsu Yoshinori, Uchikado Hisaaki, Makizono Takehiro, Miyagi Tomoya, Miyahara Takahiro
机构信息
Department of Neurosurgery, Ichinomiya Neurosurgical Hospital, Hita, Japan.
Department of Neurosurgery, Uchikado Neuro-Spine Clinic, Fukuoka, Japan.
出版信息
Surg Neurol Int. 2022 Nov 25;13:550. doi: 10.25259/SNI_967_2022. eCollection 2022.
BACKGROUND
Lumbar ligamentum flavum hematomas (LFHs) are rare. However, when they occur and contribute to epidural cauda equina compression, timely surgical intervention is frequently warranted.
CASE DESCRIPTION
A 69-year-old female presented with the left lower extremity sciatica and gait disturbance of 2 weeks' duration that ultimately evolved into a paraparesis/cauda equina syndrome. When the lumbar MRI revealed left-sided L4-L5 epidural compression attributed to a hemorrhage into the hypertrophied ligamentum flavum (HLF), she successfully underwent a bilateral fenestration/decompressive procedure. Pathologically, neovascularization and rupture of the ventral layers of the degenerated and thickened HLF contributed to the LFH.
CONCLUSION
Arterial neovascularization (i.e., arterial feeding vessels from paramuscular/prelaminar lumbar branches) contributed to a left-sided L4-L5 LFH that resulted in epidural cauda equina compression in a 69-year-old female. Following surgical focal fenestration/decompression, the patient's symptoms/signs resolved.
背景
腰椎黄韧带血肿（LFH）较为罕见。然而，当它们发生并导致硬膜外马尾神经受压时，通常需要及时进行手术干预。
病例描述
一名69岁女性出现持续2周的左下肢坐骨神经痛和步态障碍，最终发展为轻截瘫/马尾神经综合征。腰椎MRI显示左侧L4-L5硬膜外受压是由于肥厚的黄韧带（HLF）出血所致，她成功接受了双侧开窗/减压手术。病理检查显示，退变增厚的HLF腹侧层新生血管形成和破裂导致了LFH。
结论
动脉新生血管形成（即来自腰肌旁/椎板前腰椎分支的动脉供血血管）导致一名69岁女性左侧L4-L5 LFH，进而引起硬膜外马尾神经受压。手术局部开窗/减压后，患者的症状/体征消失。
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