脊髓攝影後導致的脊椎蜘蛛膜炎之探討：病例報告與文獻回顧

Post-Myelographic Arachnoiditis : A Case Report and Literature Review

林克隆(Ko-Long Lin) ； 王志龍(Jue-Long Wang) ； 賴炳宏(Ping-Hong Lai)

《中華民國復健醫學會雜誌》 30卷1期 (2002/03) Pp. 49-56

https://doi.org/10.6315/JRMA.200203.0049

摘要

脊椎蜘蛛膜炎（ spinal arachnoiditis）是一種少見且會造成嚴重殘障的疾病，其造成的成因最常見的是脊髓攝影後油性顯影劑（pantopaque）滯留或脊椎手術後遺症，解剖位置以腰椎最多見。臨床上呈現多樣化的症狀，包括難以控制的疼痛，單肢或多肢體麻痺無力，感覺異常，大小便失禁或滯留等等，並且有時好時壞的現象。病患症狀並未因時間而改善，因此有很多的學者認為它是一種「癌症」。解剖學上的病變位置和其表現的脊髓壓迫症狀並不吻合，病患因此常被誤認為有精神上異常而得不到適當治療及復健。本文除了探討脊髓攝影後導致的蜘蛛膜炎的致病機轉及脊椎蜘蛛膜炎的病狀表現之外，並且討論該疾病在MRI上的特異表現，以期及早診斷，並使病患早日獲得正確治療及整體復健，使痛苦減至最低，並協助其回復在社會中當有的角色與功能。

關鍵字

脊椎蜘蛛膜炎 ； 油性顯影劑

並列摘要

Spinal arachnoiditis (SA) is a rare disease. However, it would lead to severe disability. The most common causes of SA are post-myelographied retention of pantopaque and complications of spinal operations. The most common anatomical level is addressed to the lumbar spine. Clinically, the symptoms were diversiform, including poor-controlled pain, numbness or weakness of one or more extremities, paresthesias, bowel incontinence, bladder incontinence, and retention of urine or stool, etc. The fluctuation between progression and improvement was also noted. Because the symptoms failed to improve as time went by, many scholars viewed SA as a kind of cancer. The clinical presentation is not compatible with the signs and symptoms of spinal cord compression. Therefore, the patients didn’t receive proper treatments because their symptoms were misunderstood as results from psychical problems. The present article discussed not only the pathological mechanism of the post-myelographic SA but also the clinical symptoms and signs of SA, and the special findings on MRI images were also included. We hope to help our patients to rejoin the society by the way of early diagnosis and early treatment.

並列關鍵字

spinal arachnoiditis ； pantopaque