Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, 411005, India.
The Dean, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, 411005, India.
Spinal Cord Ser Cases. 2023 Oct 28;9(1):52. doi: 10.1038/s41394-023-00609-y.
Cervical prolapsed intervertebral disc is one of the common conditions causing cervical myeloradiculopathy. Anterior Cervical Discectomy and Fusion (ACDF) is the standard line of management for the same. Intradural neurogenic origin tumors are relatively rare and can present with features of myeloradiculopathy. Radiological imaging plays important role in diagnosis of such pathologies.
We report a patient with C5-6 cervical disc prolapse that presented with radiculopathy symptoms in the right upper limb, which was refractory to conservative care. He underwent a C5-6 ACDF and reported complete relief from symptoms at 4 weeks. He developed deteriorating symptoms over the next 10 weeks and presented at 14 weeks follow-up with severe myeloradiculopathy symptoms on the left upper limb with upper limb weakness. A fresh MRI identified an intradural extramedullary tumor with cystic changes at the index surgery level. This was treated with tumor excision and histopathology confirmed a diagnosis of schwannoma. Simultaneous presence of cord signal changes with disc herniation obscured the cystic schwannoma which became apparent later on contrast enhanced MRI imaging.
Careful review of preoperative imaging and contrast MRI study may help in diagnosing cystic schwannomas with concomitant cervical disc herniations that have cord signal changes.
颈椎间盘突出是引起颈神经根病的常见原因之一。前路颈椎间盘切除术和融合术（ACDF）是治疗该病的标准方法。硬脊膜内神经源性肿瘤相对少见，可表现为神经根病的特征。影像学检查在这些病变的诊断中起着重要作用。
我们报告了一例 C5-6 颈椎间盘突出症患者，表现为右侧上肢神经根病症状，经保守治疗无效。他接受了 C5-6 ACDF 手术，术后 4 周症状完全缓解。在接下来的 10 周内，他的症状逐渐恶化，并在 14 周的随访中出现左侧上肢严重的神经根病症状，上肢无力。新的 MRI 发现索引手术水平的硬脊膜内髓外肿瘤伴囊性变。采用肿瘤切除术治疗，组织病理学证实为神经鞘瘤。同时存在椎间盘突出伴脊髓信号改变掩盖了囊性神经鞘瘤，后来在对比增强 MRI 成像中变得明显。
仔细复习术前影像学和对比增强 MRI 研究有助于诊断伴有脊髓信号改变的同时存在的囊性神经鞘瘤和颈椎间盘突出症。
