- 期刊
Incidental Finding of a Simple Dysraphic State of a Closed Spinal Dysraphism and Tethered Cord in an Adult Patient with Low Back Pain: A Case Report
因急性下背痛意外發現成人之隱性脊柱裂及脊髓牽扯：病例報告
摘要
診斷無合併皮下腫塊（subcutaneous mass）及皮膚特徵（cutaneous stigmata）的隱性脊柱裂（closed spinaldysraphism）常需依賴已經出現之神經學或泌尿道系統相關症狀或徵象。偶爾，它可能是探究其他病因所得到的意外發現。本病例報告描述一位39歲的年輕男性發生急性下背痛而被診斷為第五腰椎的椎弓解離症（spondylolysis），腎臟輸尿管及膀胱X光顯示第一薦椎有脊柱裂（spina bifida），腰椎磁振造影則顯示在第五腰椎的位置有一硬腦膜內脂肪瘤（intradural lipoma），且合併脊髓牽扯（tethered cord）。由於病患未出現脂肪瘤所造成之腫塊效應（mass effect）及脊髓牽扯症候群（tethered cord syndrome）之相關症狀及徵象，病患接受藥物治療一週後，症狀即有改善。我們建議當病患已經出現下肢或泌尿道系統的神經功能異常時才需考慮接受手術治療，而針對沒有症狀的病患，則需教育病患脊髓牽扯症候群之相關神經學症狀，並建議定期門診追蹤，以避免發生永久性之神經功能損傷。
並列摘要
The recognition of a closed spinal dysraphism without a subcutaneous mass and cutaneous stigmata depends on the development of relevant neurological and urological symptoms and signs. It can also be an incidental finding when symptoms that do not originate from it are investigated. We describe a 39-year-old man who presented with spondylolysis-related low back pain. Plain film showed posterior spina bifida of S1 and magnetic resonance imaging of the L-spine revealed one intradural lipoma at the L5 level and cord tethering. Conservative treatment was suggested because no relevant symptoms or signs of a mass effect of the lipoma or tethered cord syndrome were observed. Surgery should be considered only in patients with neurological dysfunction of the lower limbs or urological deficits. We emphasize the role of patient education when monitoring the symptoms and signs of patients with tethered cord in order to prevent permanent neurological deficits.