Al-Khodairy A T, Gobelet C, Nançoz R, De Preux J
Department of Physical Medicine and Rehabilitation, Hôpital de Gravelone, Sion, Switzerland.
Eur Spine J. 1997;6(5):336-41. doi: 10.1007/BF01142682.
We report the case of a 74-year-old woman who presented with acute-onset right groin pain irradiating to the thigh anteriorly after having suffered for a few weeks from slight knee pain. As a CT scan showed multiple herniated intervertebral discs and spinal stenosis at the L3-L4 level, she was referred to a neurosurgical unit with the tentative diagnosis of L2-L3 radicular pain. Investigations (MR, myelography with CT scan) showed severe acquired lumbar canal stenosis. Decompression surgery was finally postponed because of the patient's serious cardiac medical history and she was referred to us for conservative treatment. She was found to have iliopsoas bursitis with chondrocalcinosis of the knee. Local steroid injections of the two sites abolished her symptoms. We draw attention to the possible pitfalls that the radiographic appearance and one of the multiple clinical presentations of this unrare pathology may represent. Whenever a patient comes walking with crutches, avoids putting weight on his or her leg, and radicular pain is suspected, we advise consideration of other extra-spinal causes for the pain.
我们报告了一例74岁女性患者的病例。该患者在经历了数周的轻微膝关节疼痛后，突然出现右腹股沟疼痛，并向前放射至大腿。由于CT扫描显示多个椎间盘突出和L3 - L4水平的椎管狭窄，她被转诊至神经外科，初步诊断为L2 - L3神经根性疼痛。进一步检查（磁共振成像、CT脊髓造影）显示严重的后天性腰椎管狭窄。由于患者有严重的心脏病史，减压手术最终推迟，她被转诊至我们这里进行保守治疗。结果发现她患有髂腰肌滑囊炎和膝关节软骨钙质沉着症。对这两个部位进行局部类固醇注射后，她的症状消失了。我们提请注意这种并不罕见的病理状况在影像学表现和多种临床表现之一中可能存在的潜在陷阱。每当有患者拄着拐杖行走、避免腿部负重且怀疑有神经根性疼痛时，我们建议考虑疼痛的其他脊柱外原因。
