Mizuno J, Nakagawa H, Iwata K
No Shinkei Geka. 1986 Apr;14(5):681-5.
A 55-year-old man came to our hospital, complaining of progressive deterioration of gait disturbance 13 years following C4-7 laminectomy. Neurological examination showed marked spastic gait, hyperreflexia in the lower limbs, ankle clonus, hypesthesia below C5, and loss of position and vibratory sensations in great toes. Preoperative metrizamide CT clearly demonstrated pseudomeningocele and cervical cord herniation through the dural defect at C6-7 and narrow canal at C3. Moreover, sagittal and coronal reconstructions reveal a clear-cut posterior displacement of the cervical cord with posterior protrusion of the cord through the possible dural defect and the obvious extent of pseudomeningocele. At the operation, herniation of the posterior aspect of the cord through the dural defect at C6-7 was encountered as well as pseudomeningocele from the leakage at the C5 level. The cause of spinal cord herniation is classified into i) congenital, ii) traumatic, iii) iatrogenic. An iatrogenic spinal cord herniation is rare and its preoperative diagnosis used to be hard. Discussion was made on the points of preoperative diagnosis of a postoperative spinal cord herniation by metrizamide CT.
一名55岁男性因C4 - 7椎板切除术后13年步态障碍进行性加重前来我院就诊。神经系统检查显示明显的痉挛性步态、下肢反射亢进、踝阵挛、C5以下感觉减退以及大脚趾位置觉和振动觉丧失。术前甲泛葡胺CT清晰显示假性脊膜膨出以及颈髓通过C6 - 7硬膜缺损处疝出和C3处椎管狭窄。此外，矢状位和冠状位重建显示颈髓明显向后移位，脊髓通过可能的硬膜缺损向后突出，假性脊膜膨出范围明显。手术中，发现颈髓后份通过C6 - 7硬膜缺损处疝出，同时存在C5水平渗漏导致的假性脊膜膨出。脊髓疝的病因分为：i）先天性，ii）创伤性，iii）医源性。医源性脊髓疝罕见，术前诊断曾很困难。本文就甲泛葡胺CT对术后脊髓疝的术前诊断要点进行了讨论。
