Multiple Osseous Loose Bodies Associated with Lumbar Isthmic Spondylolisthesis.
Multiple Osseous Loose Bodies Associated with Lumbar Isthmic Spondylolisthesis.
复制标题
与腰椎峡部滑脱相关的多处骨质疏松体。
DOI：
10.1016/j.wneu.2016.06.073
复制
发表时间：
2016
期刊：
影响因子：
2
通讯作者：
Nakase H.
中科院分区：
文献类型：
--
作者：
Takeshima Y;Hanakita J;Takahashi T;Nakase H.
背景腰椎多发性骨游离体未见报道。我们描述了一种罕见的手术病例多骨游离体与腰椎峡部裂性脊椎前移。Case DescriptionA 74岁的男子谁经历了左脚麻木和双侧臀部疼痛被诊断为腰椎滑脱7年前和管理保守。他报告6个月前左脚麻木复发，当时考虑积极（而不是保守）治疗。腰椎X线片显示L5峡部裂性脊椎前移，L5/S1动态不稳定。腰椎磁共振成像显示多个肿块病变背侧位于腰椎管。计算机断层扫描脊髓造影显示L5节段峡部附近有多处骨质，病变压迫硬膜囊导致腰椎管狭窄。患者接受了后路减压手术，完全切除了骨性病变。术中发现骨病变位于纤维软骨材料中，L5节段或黄韧带的溶解部分没有连接。术后过程中的病人是平安无事的，他的神经症状improved.ConclusionsWe描述了第一个实例的多个游离体在椎管腰椎管狭窄症。据推测，长期存在的轻微创伤，由于动态不稳定与骨化过度的趋势诱导继发性滑膜骨软骨瘤病形成多个游离体。
BackgroundMultiple osseous loose bodies in the lumbar spine have never been reported. We describe a rare surgical case of multiple osseous loose bodies associated with lumbar isthmic spondylolisthesis.Case DescriptionA 74-year-old man who experienced left foot numbness and bilateral gluteal pain was diagnosed with lumbar spondylolisthesis 7 years previously and managed conservatively. He reported recurrence of the left foot numbness 6 months previously, at which time aggressive (rather than conservative) therapy became a consideration. Radiographs of the lumbar spine revealed L5 isthmic spondylolisthesis with dynamic instability at L5/S1. Magnetic resonance imaging of the lumbar spine revealed multiple mass lesions dorsally located in the lumbar canal. Computed tomography myelography demonstrated multiple osseous materials near the isthmic portion at the L5 level where compression of the dural sac by the lesions induced lumbar canal stenosis. The patient underwent posterior decompression surgery that enabled total removal of the osseous lesions. Intraoperative findings revealed osseous lesions located in the fibrocartilage material and no connection of the lytic portion at the L5 level or ligamentum flavum. Postoperative course of the patient was uneventful as his neurological symptoms improved.ConclusionsWe described the first instance of multiple loose bodies in the spinal canal with lumbar canal stenosis. It is presumed that long standing minor trauma due to dynamic instability with a trend of hyperossification induced secondary synovial osteochondromatosis forming multiple loose bodies.