An unusual case of footdrop: anterior disc herniation mimicking a nerve sheath tumor.
An unusual case of footdrop: anterior disc herniation mimicking a nerve sheath tumor.
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DOI：
10.1227/01.neu.0000363406.81956.a9
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发表时间：
2010-02-01
期刊：
影响因子：
4.8
通讯作者：
Levi, Allan D
中科院分区：
文献类型：
--
作者：
Levene, Howard B;Nimmagadda, Anitha;Levi, Allan D
目的：描述极端外侧椎间盘突出症。通常，椎间盘突出被描述为位于神经孔的外侧边缘。超出该位置的突出椎间盘需要纳入影响神经根的腹膜后病变的鉴别中。临床表现：一名 76 岁的女性出现左腿神经根症状，包括足下垂和腹膜后病变。考虑到病变的位置及其距神经孔边缘的距离，鉴别诊断倾向于神经鞘瘤。干预：采用前腹膜后入路。手术时，病变被证明是腰肌内侧 L5-S1 椎间盘间隙前表面的椎间盘突出。椎间盘突出导致 L5 神经根严重受压，因为该神经根连接腰骶丛。这种更为严重的外侧椎间盘突出症尚未得到广泛报道。在这个位置，有报告称临床医生将椎间盘与肿瘤混淆，有时将肿瘤与椎间盘混淆。鉴于某些椎间盘突出症在视觉上不再与椎间孔相邻，也许极端外侧椎间盘突出症并不是一个理想的术语。本病例报告还补充了有关这种罕见病症的文献综述，具体搜索了椎间盘突出、腹膜后突出、前路突出。 结论：使用前路椎间盘突出一词将有助于临床医生将突出的椎间盘碎片纳入影响腹膜后位置脊柱前神经根的病变的鉴别诊断中。
OBJECTIVE: Extreme lateral disc herniations are described. Usually, the herniated disc is described as being at the lateral edge of the neural foramen. Herniated discs that lodge beyond this location need to be included in the differential of retroperitoneal lesions impinging on nerve roots.CLINICAL PRESENTATION: A 76-year-old woman presented with left leg radicular symptoms, including footdrop and a retroperitoneal lesion. Given the location of the lesion and its distance from the edge of the neural foramen, the differential diagnosis favored a nerve sheath tumor.INTERVENTION: An anterior retroperitoneal approach was taken. At the time of surgery, the lesion proved to be a herniated disc arising from the anterior surface of the L5-S1 disc space, medial to the psoas muscle. The disc herniation resulted in severe compression of the L5 nerve root as the root joined the lumbosacral plexus. This type of even more extreme lateral disc herniation is not widely reported. At this location, there are reports of clinicians confusing discs for tumors and occasionally tumors for discs. Given that some disc herniations are no longer visually adjacent to the foramen, perhaps extreme lateral disc herniation is not an ideal term. This individual case report is supplemented with a review of the literature on this rare condition with specific searches for disc, retroperitoneal, anterior herniation.CONCLUSION: Using the term anterior disc herniation will aid clinicians in including herniated disc fragments in the differential diagnosis for lesions affecting nerve roots anterior to the spine in this retroperitoneal location.