Lisheng Hou, Dong Zhang, Xuedong Bai, Jinglei Shi, Shaokui Nan, Tianjun Gao, Feng Ge, Qing He
Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China.
Senior Department of Traditional Chinese Medicine, The Sixth Medical Center of PLA General Hospital, Beijing, China.
Front Surg. 2023 Jan 11;9:1077343. doi: 10.3389/fsurg.2022.1077343. eCollection 2022.
A retrospective case report.
To report a case who developed deteriorated paraplegia by spontaneous spinal epidural hematoma (SSEH) based on calcification of the ligamentum flavum (CLF) at the T10-11 level, achieved full neurological recovery following posterior percutaneous endoscopic surgery (PPES).
CLF rarely occurs at the thoracic spine, and the symptom usually progress slowly. SSEH is another rare spinal lesion that might progress rapidly and cause emergent severe spinal cord compression syndrome. Coexistence of SSEH and CLF at the same thoracic level was rarely reported in English literature.
A 65-year-old man presented to our hospital with the complaint of sensorimotor loss on the lower limbs and dysfunction of bladder for 1 day after a progressive weakness and numbness of the lower limbs for 3 months. MR examination found a dorsal protruding mass at the T10-11 level, while computed tomography (CT) found the protruding mass contained scattered calcified deposits. The patient was diagnosed with thoracic CLF. Decompression PPES was carried out to realize bilateral decompression through a unilateral approach.
During the operation, the protruding mass was found to be composed of SSEH and CLF together. After the operation, the patient's neurological function recovered quickly. One week later, the patient could walk by himself. After 3 months, complete neurological function had recovered.
SSEH could develop based on CLF at thoracic level and cause serious neurological dysfunction. PPES might be an advisable method to remove CLF and evacuate SSEH with good clinical results.
一项回顾性病例报告。
报告一例因胸10 - 11节段黄韧带钙化（CLF）导致自发性脊髓硬膜外血肿（SSEH）并出现截瘫加重的病例，该患者在接受经皮后路内镜手术（PPES）后神经功能完全恢复。
CLF在胸椎很少发生，症状通常进展缓慢。SSEH是另一种罕见的脊柱病变，可能进展迅速并导致紧急严重脊髓压迫综合征。英文文献中很少报道同一胸段水平SSEH和CLF共存的情况。
一名65岁男性因下肢进行性无力和麻木3个月后，出现下肢感觉运动丧失及膀胱功能障碍1天前来我院就诊。磁共振成像（MR）检查发现胸10 - 11节段有一个背侧突出肿块，而计算机断层扫描（CT）发现突出肿块内有散在钙化灶。该患者被诊断为胸椎CLF。实施PPES减压术，通过单侧入路实现双侧减压。
术中发现突出肿块由SSEH和CLF共同组成。术后患者神经功能迅速恢复。1周后，患者可自行行走。3个月后，神经功能完全恢复。
SSEH可基于胸椎水平CLF发生并导致严重神经功能障碍。PPES可能是一种可取的方法，用于切除CLF和清除SSEH，临床效果良好。
