Rosenberg W S, Salame K S, Shumrick K V, Tew J M
Department of Neurosurgery, University of California, San Francisco, USA.
Spine (Phila Pa 1976). 1998 Jul 1;23(13):1497-500. doi: 10.1097/00007632-199807010-00013.
A case is reported in which a flexion-induced compression of the upper cervical spinal cord caused symptoms of brainstem compromise in the absence of radiographic evidence of osseous instability.
A 41-year-old woman developed postoperative cervical instability with flexion-induced neurologic symptoms referable to the brainstem. The instability was caused by direct compression at the third cervical vertebral body, which in turn was caused by differential movements between the neuraxis and skeletal elements in the upper cervical spine.
Pathologic processes at the craniocervical junction may cause brainstem compromise with neurologic symptoms. The mechanism of brainstem involvement is usually either vertebrobasilar insufficiency or direct mechanical compression. In cases where the brainstem is compressed by skeletal elements, the compressing osseous structures usually are the walls of the foramen magnum or the odontoid process, or, less frequently, the atlas or axis vertebrae. Symptoms of brainstem dysfunction caused by dynamic compression at the level of the third cervical vertebra in the absence of hindbrain herniation are unusual and, to the best of the authors' knowledge, have not been described previously.
The patient underwent initial examination, evaluation, and periodic follow-up examination with magnetic resonance imaging from the time of her first visit until 26 months after the surgical treatment. The patient experienced postsurgical instability with dynamic compression by the C3 vertebral body, which caused brainstem compromise. Surgical treatment consisted of decompressive C3 corpectomy and fusion of C2 to C6, supplemented by anterior fixation.
After undergoing surgical decompression of C3, reconstruction, and anterior internal fixation of C2 to C6, the patient had dramatic neurologic improvement. Diplopia, paresthesia, and nystagmus disappeared immediately after surgery. Swallowing difficulties, hoarseness, and vertigo improved gradually. At follow-up examination 26 months after surgery, the patient was asymptomatic. Magnetic resonance imaging showed good position of the construct, with no evidence of compression of the spinal cord or brainstem.
Instability of the cervical spine may result in symptoms of brainstem dysfunction, even in the absence of hindbrain herniation. This instability is explained by the differential movement between the bony structures and neuraxis in the upper cervical region. Diagnosis and adequate management of this instability alleviates the neurologic symptoms and prevents possible hazardous complications.
报告一例病例，其中上颈髓的屈曲性压迫在无骨质不稳定影像学证据的情况下导致脑干受损症状。
一名41岁女性术后出现颈椎不稳定，伴有由屈曲引起的、可归因于脑干的神经症状。这种不稳定是由第三颈椎椎体的直接压迫所致，而这又是由上颈椎神经轴与骨骼结构之间的差异运动引起的。
颅颈交界区的病理过程可能导致脑干受损并出现神经症状。脑干受累的机制通常是椎基底动脉供血不足或直接机械压迫。在脑干被骨骼结构压迫的病例中，压迫性骨质结构通常是枕骨大孔壁或齿突，或者较少见的是第一颈椎或第二颈椎椎体。在无后脑疝的情况下，由第三颈椎水平的动态压迫引起的脑干功能障碍症状并不常见，据作者所知，此前尚未有过描述。
从患者首次就诊直至手术治疗后26个月，对其进行了初次检查、评估，并定期通过磁共振成像进行随访检查。患者术后出现不稳定，C3椎体动态压迫导致脑干受损。手术治疗包括C3椎体次全切除减压及C2至C6融合，并辅以前路固定。
在接受C3手术减压、重建以及C2至C6前路内固定后，患者神经功能显著改善。复视、感觉异常和眼球震颤在术后立即消失。吞咽困难、声音嘶哑和眩晕逐渐改善。术后26个月的随访检查中，患者无症状。磁共振成像显示植入物位置良好，无脊髓或脑干受压迹象。
颈椎不稳定可能导致脑干功能障碍症状，即使在无后脑疝的情况下也是如此。这种不稳定可由上颈椎区域骨结构与神经轴之间的差异运动来解释。对这种不稳定进行诊断并给予适当处理可缓解神经症状并预防可能的危险并发症。
