轉移性攝護腺癌合併腰椎壓迫性骨折及脊柱狹窄：病例報告暨文獻回顧

一位七十二歲男性，一年前曾發生第一腰椎壓迫性骨折。病人因近期跌倒造成第一腰椎爆裂性骨折合併馬尾症候群而接受手術，術後可使用助行器走路，但仍主訴持續背痛。術後二個月，病人不幸於兩天內下肢癱瘓，神經檢查發現兩下肢肌力零到壹分，胸椎第十皮節以下感覺障礙及兩側出現巴班司基氏反射(Babinski response)。X-光檢查發現第九胸椎體有成骨性病變，磁振造影檢查顯示胸椎有多處等強度至低強度病兆並壓迫第九胸椎附近之胸髓，經証實為攝護腺癌合併骨轉移。本例提醒臨床醫師，背痛病人需小心檢查肌力強度、感覺、深部肌腱反射及可能出現之上神經元徵象；即使在已有壓迫性骨折及脊椎狹窄之老人，若有復發生背痛，仍要考慮轉移性癌症之可能性。對背痛及骨頭破壞之病人早期詳細之脊椎X 光攝影及磁振造影檢查有助早日發現脊髓壓迫，以避免嚴重不可逆之傷害。

關鍵字

癌症；脊髓壓迫；磁振造影

並列摘要

We reported a 72 y/o male who had past history of old L1 compression fracture for 1 year. He suffered from falling down accidentally and was operated under impression of L1 burst fracture with cauda equina syndrome. He could ambulate with walker, but persistent back pain was still complained. Two months after operation, he became paralyzed rapidly in 2 days. Neurological examinations showed decreased motor strength of bilateral lower extremities to grade 0-1/5, sensory deficit below T10 dermatome and bilateral extensor plantar response. X-ray film showed an osteoblastic lesion in T9 vertebra body. Magnetic resonance Imaging (MRI) of thoracic spine revealed multiple iso-to-hyposignal intensity lesions diffusely involving of thoracic spine and compression of spinal cord at T9 level. Metastatic tumor was highly suspected. Prostate needle biopsy confirmed the primary origin of prostatic adenocarcinoma. This case illustrated that metastatic bone tumor should be considered as one of the etiologies of recurrent back pain, even in elderly patients with known history of compression fracture and spinal stenosis. We emphasize the importance of careful clinical examination of patients with back pain, including an assessment of motor strength, sensation, deep tendon reflexes and upper motor neuron signs. The use of spine radiographs and MRI is recommended for patients with back pain and bony destruction for early diagnosis of epidural spinal cord compression before the onset of neurologic symptoms.

並列關鍵字

cancer ； spinal cord compression ； MRI

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轉移性攝護腺癌合併腰椎壓迫性骨折及脊柱狹窄：病例報告暨文獻回顧

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