Autonomic Dysreflexia in Ankylosing Spondylitis with Double Spinal Cord Injuries: A Case Report

僵直性脊椎炎併雙位脊髓損傷患者之自主神經異常反射：病例報告

黃書群(Shu-Chun Huang) ； 蔡文鍾(Wun-Jhong Tsai) ； 周適偉(Shih-Wei Chou) ； 王錦滿(Chin-Man Wang) ； 黃美涓(Alice M. K. Wong)

《台灣復健醫學雜誌》 35卷3期 (2007/09) Pp. 171-177

https://doi.org/10.6315/2007.35(3)07

摘要

本文報告一位長期罹患僵直性脊椎炎的五十四歲病人，外傷後發生頸部脊髓損傷以及一開始未被發現的微小腰椎第一節椎體骨折。頸椎固定手術後一個月，病人在坐姿接受復健治療的墊上運動時出現至少三次自主神經異常反射的症狀及徵候，躺臥後迅速改善。神經學檢查相較一個月前，呈現深部肛門感覺喪失、感覺皮節高度的改變。影像學及病理學檢查後，診斷為僵直性脊椎炎併發進展性腰椎第一節橫斷性骨折(transverse fracture)並造成脊髓壓迫。該病人接受椎板切除術(laminectomy)減壓以及胸椎第十二節和腰椎第二節的椎弓腳補釘固定術(transpedicle screws fixation)，但術後一個月病人有下背部異常感，X光檢查顯示腰椎第一節崩塌。該病人接受第二次手術，包括胸椎第十一、十二節及腰椎第二、三節的椎弓腳補釘固定術，脊椎體骨移植(bone autograft)。術後至今十八個月，該病人自主神經異常反射的症狀以及腰痛已獲得解除，並順利接受復健訓練。本文主要討論罕見之脊椎橫斷性骨折誘發姿勢性自主神經異常反射之成因、診斷和適當的外科處理。該病例沒能在第一時間做出腰椎骨折的診斷以及兩次的脊椎手術都可以作為臨床醫師處理類似僵直性脊椎病患之參考。

關鍵字

不穩定脊椎 ； 脊椎橫斷性骨折 ； 僵直性脊椎炎 ； 自主神經異常反射 ； 脊髓損傷

並列摘要

This 54-year-old man underlying ankylosing spondylitis suffered from double spinal cord injuries with traumatic C6/7 dislocation and a neglected L1 vertebral body fracture which progressed to transverse fracture three weeks after the injury, acting as a powerful precipitant to autonomic dysreflexia. The dysreflexic symptoms happened at least three times when he practiced sitting during mat exercise and ameliorated soon by virtue of lying down. Compared with the previous record checked three weeks ago, neurologic examination revealed alteration of sensory level and loss of deep anal sensation. The patient received L1 laminectomy as well as T12 and L2 transpedicle screws fixation, but L1 vertebral body was collapsed one month after the operation. In the second operation, T11-L3 pedicle screws fixation with cross links and L1 intrabody bone autografts were performed. After that, the dysreflexic symptoms were relieved. To our knowledge, there are not many case reports describing that the instability of spine may trigger autonomic dysreflexia. Therefore, as posture induced autonomic dysreflexia or new neurological deficits occur in high level SCI, the differential diagnosis may include a second spine lesion that causes unstable spine.

並列關鍵字

unstable spine ； spinal transverse fracture ； ankylosing spondylitis ； autonomic dysreflexia ； spinal cord injury