馬尾症候群和腰椎間盤突出症

Cauda Equina Syndrome and Lumbar Disc Herniation

鍾進燈(Chinn-Dong Chung) ； 周崇頌(Chorng-Sonq Chou) ； 徐道昌(Tao-Chang Hsu)

《中華民國復健醫學會雜誌》 16期 (1988/12) Pp. 88-93

摘要

腰椎間盤突出引起下背痛，在臨床上相當常見，但是因它引起馬尾壓迫則相當少見，典型的馬尾症候群有複雜性下背痛，單側或雙側坐骨神經痛，鞍部麻木，下肢無力，進而肛門和膀胱失禁。馬尾症候群需要儘快診斷和手術治療，否則會造成永久性的後遺症。臨床檢查包括病史，理學檢查，脊髓造影，電腦斷層攝影，膀胱功能檢查，神經傳導速度和肌電波檢查。一年半中本科共發現三例，本文就其病史，誘因，檢查過程，手術發現，門診追蹤，參考文獻加以分析討論。

並列摘要

Hearniation of lumbar disc (HIVD) causing compression of the cauda equina is rare but needs urgent diagnosis and surgical treatment. Cauda equina syndrome (CES) has been described as a complex of low back pain, bilateral or unilateral sciatica, saddle anesthesia and motor weakness in the lower extremities that may progress to paraplegia with bowel and urinary bladder incontinence. The onset of bladder and rectal paralysis with saddle anesthesia should be viewed with a high index of suspicion in a patient with backache and sciatica. Three C.E.S. cases out of 169 H.I.V.D. cases who had been operated in our hospital were seen over a period of one and a half year. The clinical examination included history, physical examination and special examinations that were myelogram, C-T scanning, Urodynamic study, NCV and EMG study. All three cases had history of chronic relapsing low back pain for four to thirty years. Two out of three had oblivious traumatic injury and the other case did not.
The backache and sciatia showed dramatic improvement in all three cases after operation but saddle hypesthesis, motor weakness and areflexic bladder were still present. The bladder control recovered within six months after operation in all three cases even though urinary bladder showed poor compliance in urodynamic study. However, recovery of sensory, motor and sexual functions was incomplete one year after operation.

並列關鍵字

cauda equina syndrome ； H.I.V.D. ； urodynamic study ； myelogram