Pseudomeningocele Following Lumbar Surgery as a Cause of Low Back Pain: Report of a Case

我們報告一個腰椎手術後因不慎造成脊膜損傷而引起假性脊髓脊膜突出，病人起初求助於疼痛科，但沒有被診斷出來。假性脊髓脊膜突出可能會因脊椎手術中不慎造成脊膜損傷而使得脊髓液聚集而引發。這是一個罕見的脊椎手術合併症。一個69歲女性在7年前因爲脊椎狹窄接受腰椎椎弓切除手術，但在術後六年因持續性背痛合併坐骨神經痛而求診於疼痛科。病人接受一段長期藥物治療仍不見起色。由脊椎攝影在第二及第三腰椎間發現一個假性脊髓脊膜突出，且磁振攝影亦証實。病人接受切除手術後，背痛及神經疼痛症狀獲得改善。如果病人曾接受腰椎手術而仍有持續性疼痛症狀，此一少見的合併症仍要考慮。

關鍵字

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並列摘要

This paper reports a case of postoperative pseudomeningocele, which was not diagnosed initially with clinical data alone; the condition was caused by an inadvertent meningeal tear that occurred during spinal surgery. Pseudomeningocele formation is a rare postoperative complication of spinal surgery characterized by the extradural accumulation of cerebrospinal fluid following extravasation through an inadvertent dural tear. A 69-year-old woman had undergone laminectomy and posterolateral fusion at the L3-L5 level 7 years previously, for spondylolisthesis with spinal stenosis syndrome; the postoperative course was uneventful. Six years after the surgery, the patient experienced increasingly severe low back pain radiating to both gluteal regions. After prolonged but unresponsive conservative treatment, a large pseudomeningocele at the L2-L3 level was identified by myelography. The findings of MRI supported the diagnosis of pseudomeningocele. Surgery via the posterior approach exposed the pseudomeningocele after a complete laminectomy of L2-L4. The pseudomeningocele was excised 7 years after the initial operation. Complete recovery and excellent remission of symptoms was noted at 6 months after the surgery. Pseudomeningocele must always be considered as a cause of chronic back pain in patients who have undergone previous lumbar surgery, no matter how many years after the surgical procedure the symptoms may occur.

並列關鍵字

low back pain ； postlaminectomy ； pseudomeningocele

國際替代計量

Pseudomeningocele Following Lumbar Surgery as a Cause of Low Back Pain: Report of a Case

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