Itoh M, Shima K, Ishikawa S, Ono Y
No Shinkei Geka. 1978 Jun;6(6):591-7.
A case of cervical canal stenosis accompanied by congenital cervical fusion and extracerebral occlusive disease of the verebral artery was reported. A 39-year-old male was admitted to our hospital on June 5, 1976, because of his shoulder strain, motor weakness and numbness of his left hand, and gait disturbance for a couple of months. Neurological examination disclosed spastic paraparesis with positive pyramidal signs in the four extremities which was greater on the left side, and the superficial and deep sensations were diminished below C-4 dermatomes bilaterally. Spinal tap revealed crystal clear fluid under an initial pressure equivalent to 120 mm of water with a protein content of 20 mg/dl. Plain X-P and laminogram of the cervical spine showed congenital fusion of C 2-3, cervical canal stenosis and cervical spondylosis. Posterior spurring of C 3-4 was demonstrated only on the laminogram. Myelogram showed incomplete myelographic block at the site of C 3-4-5. The left retrograde brachial angiogram disclosed occlusion of the vertebral artery at the site of C3-4. where the proxymal vertebral artery anastomosed with the well developed muscular branch of the vertebral artery, taking a tortuous course at the leve of the transverse foramen of the atlas, and were opacified the distal vertebral artery and basilar artery. Each collateral flow extending from the deep cervical artery and ascending cervical artery anastomosed with the proxymal and distal portion of the occluded vertebral artery. In spite of conservative treatment for two weeks, the cord compression syndromes rather deteriorated. Posterior decompression, that is, C 2-7 laminectomy and C 3-4 partial facetectomy were performed for relieving the symptoms. The postoperative course was uneventfull and there was progressive improvement of the sensory, motor and gait disturbance. The relationship betwen the cervical canal stenosis and cervical spondylosis and their clinco-radiological problem were discussed. The close embryological relationship was very suggestive of the pathogenesis between the cervical bony lesion and congenital cervical fusion and the occlusive vascular lesion of the vertebral artery.
报告了一例伴有先天性颈椎融合和椎动脉颅外闭塞性疾病的颈椎管狭窄病例。一名39岁男性于1976年6月5日因肩部劳损、左手运动无力和麻木以及步态障碍数月入住我院。神经系统检查发现痉挛性截瘫，四肢锥体束征阳性，左侧更明显，双侧C-4皮节以下浅感觉和深感觉减退。腰椎穿刺显示初压相当于120mm水柱，脑脊液清亮，蛋白含量为20mg/dl。颈椎正位X线片和断层片显示C 2-3先天性融合、颈椎管狭窄和颈椎病。仅在断层片上显示C 3-4后缘骨赘形成。脊髓造影显示C 3-4-5水平不完全性脊髓造影阻断。左侧逆行肱动脉造影显示椎动脉在C3-4水平闭塞，此处近端椎动脉与发育良好的椎动脉肌支吻合，在寰椎横突孔水平走行迂曲，造影剂使远端椎动脉和基底动脉显影。从颈深动脉和颈升动脉延伸的每条侧支血流与闭塞椎动脉的近端和远端部分吻合。尽管进行了两周的保守治疗，脊髓压迫综合征仍恶化。为缓解症状进行了后路减压，即C 2-7椎板切除术和C 3-4部分小关节切除术。术后过程顺利，感觉、运动和步态障碍逐渐改善。讨论了颈椎管狭窄与颈椎病之间的关系及其临床放射学问题。紧密的胚胎学关系非常提示颈椎骨病变与先天性颈椎融合以及椎动脉闭塞性血管病变之间的发病机制。
