Scuola di Specializzazione in Ortopedia e Traumatologia, Università degli Studi di Milano, Milano, Italy
Second Spinal Surgery Unit, IRCCS Galeazzi-Sant'Ambrogio Hospital, Milano, Italy.
BMJ Case Rep. 2024 Mar 13;17(3):e257373. doi: 10.1136/bcr-2023-257373.
We present the case of a man in his 40s who sought medical attention due to central cord syndrome. MRI findings demonstrated contrast uptake, spinal swelling, syrinx formation and narrowing of the spinal canal. We encountered two potential scenarios:when malignancy is suspected, the patient would undergo a biopsy. However, if the lesion is ultimately determined to be benign, the patient would have been subjected to an avoidable risk of neurological damage associated with the procedure. Conversely, addressing the lesion as a result of a degenerative process (discal instability), performing an anterior approach for interbody fusion with an underlying malignant process could lead to substantial delays in the diagnosis, finally producing a poor outcome. A comprehensive imaging workup was conducted to rule out malignancy. We hypothesised that discal instability was responsible for the observed findings. The patient was successfully treated with anterior cervical decompression and fusion, without complications. Follow-up evaluations confirmed remission of the condition.
我们报告了一例 40 多岁男性因中央脊髓综合征就诊的病例。MRI 结果显示对比增强、脊髓肿胀、脊髓空洞形成和椎管狭窄。我们遇到了两种潜在情况:如果怀疑恶性肿瘤,患者将进行活检。然而,如果病变最终被确定为良性,患者将承受与该过程相关的可避免的神经损伤风险。相反,如果将病变视为退行性过程(椎间盘不稳定),在前路进行椎间融合术治疗潜在的恶性病变,可能会导致诊断出现重大延误,最终导致不良结果。进行了全面的影像学检查以排除恶性肿瘤。我们假设椎间盘不稳定是导致观察到的结果的原因。患者在前路颈椎减压和融合治疗后成功,无并发症。随访评估证实病情缓解。