Nishi S, Hashimoto N, Takagi Y, Tsukahara T
Department of Neurosurgery, National Cardio-Vascular Center, Osaka, Japan.
Spine (Phila Pa 1976). 1995 Dec 1;20(23):2576-9. doi: 10.1097/00007632-199512000-00020.
The authors encountered a unique case of nerve root herniation 9 days after multiple lumbar partial hemilaminectomies with discectomy were performed for lumbar canal stenosis combined with lumbar disc hernia.
The treatment of this patient involved surgical repair even though the dural laceration was small and the arachnoid was intact.
There have been no reports of nerve root herniation into the facet joint through the arachnoid space after laminectomy, except in cases of extradural distention of the arachnoid membrane.
The patient presented with weakness of the right lower extremity and underwent partial hemilaminectomies and discectomy for lumbar canal stenosis. Nine days after surgery, he suddenly experience severe pain in the left S1 region. Neither myelography nor computed tomography-myelography revealed pathologic findings before the second operation. At surgery, herniation of the S1 nerve root was found. Surgical correction of the herniated nerve root at the level of the left L5 vertebra was performed.
This correction completely relieved the pain in the left S1 region.
This herniation resulted from an unrepaired minor dural laceration. The arachnoid membrane was intact during the first operation. Even a small tear in the spinal dura requires surgical closure to prevent herniation and entrapment of a nerve root. It is necessary to repair even small dural lacerations with no spinal fluid leakage during spinal surgery.
作者遇到了一例独特的病例，该患者在因腰椎管狭窄合并腰椎间盘突出症接受多次腰椎部分半椎板切除术及椎间盘切除术9天后出现神经根疝。
尽管硬脑膜撕裂较小且蛛网膜完整，但对该患者的治疗仍采用了手术修复。
除了蛛网膜硬膜外扩张的病例外，尚无关于椎板切除术后神经根通过蛛网膜下腔疝入小关节的报道。
该患者表现为右下肢无力，因腰椎管狭窄接受了部分半椎板切除术及椎间盘切除术。术后9天，他突然感到左S1区域剧痛。在第二次手术前，脊髓造影和计算机断层扫描脊髓造影均未发现病理改变。手术中发现S1神经根疝出。对左侧L5椎体水平的疝出神经根进行了手术矫正。
这种矫正完全缓解了左S1区域的疼痛。
这种疝出是由未修复的轻微硬脑膜撕裂引起的。第一次手术时蛛网膜完整。即使是脊髓硬脑膜上的小裂口也需要手术缝合，以防止神经根疝出和受压。在脊柱手术中，即使是没有脑脊液漏出的小硬脑膜撕裂也有必要进行修复。
