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題名 | Exacerbation of Symptoms of Lumbar Disc Herniation Complicated by a Schwannoma: A Case Report=腰椎椎間盤突出症合併神經鞘瘤導致症狀惡化--病例報告 |
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作者 | 劉森永; 林岳民; 魏大森; 林珊如; 劉真真; 周啟文; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷期 | 23:9 2007.09[民96.09] |
頁次 | 頁480-485 |
分類號 | 416.293 |
關鍵詞 | 馬尾症候群; 椎間盤突出; 神經鞘瘤; Cauda equina syndrome; Intervertebral disc herniation; Schwannoma; |
語文 | 英文(English) |
中文摘要 | 腰椎椎間盤突出症為下背痛常見的原因之一,接受保守之治療如:腰椎牽引等物理治療,通常有療效;腰椎脊柱中產生之神經鞘瘤並不多見,產生臨床症狀亦與腰椎椎間盤突出症相似,不易診斷。本例為一位 51 歲男性患者,3 年前有下背痛的情形,於 2 年前經磁振掃描證實 L2/L3 之腰椎間盤突出症,經保守治療改善後,於一年前下背痛復發,經保守治療症狀持續改善,但於二個月前症狀突然惡化,並感覺排尿困難與下肢無力等馬尾症候群,後經磁振掃描檢查意外發現於 L2/L3 腰椎間盤突出處有一小顆神經鞘瘤,造成腰椎狹窄使症狀加劇。患者後來接受椎板切除術並腫瘤移除和椎間盤切除術,患者經追蹤半年,目前症狀解除,唯左側臀部仍遺存麻木感。結論:經保守治療且症狀改善之腰椎椎間盤突出症,若症狀突然惡化,則須再詳細詢問病史與理學檢查,並配合進一步的檢查,如磁振掃描與顯影劑使用,以確定診斷避免延誤病情。 |
英文摘要 | Herniation of the lumbar disc is a common cause of low back pain. Conservative management with physiotherapy, such as lumbar spine traction, is usually effective. Although a schwannoma of the lumbar spine is relatively uncommon, the clinical manifestations are similar to those of lumbar disc herniation, making the diagnosis difficult. This case report describes a 51-year-old male who had suffered from low back pain for 3 years and who was diagnosed with L2/L3 lumbar disc herniation. The low back pain was well-controlled by conservative treatment and the symptoms improved progressively. Two months prior to our evaluation, however, the symptoms worsened acutely, and were accompanied by the onset of symptoms of cauda equina syndrome. A small tumor at the site of the L2/L3 disc herniation, observed incidentally during magnetic resonance imaging, was responsible for the symptoms of spinal stenosis at the lumbar region. The patient underwent laminectomy, tumor resection, and discectomy with near-complete resolution of symptoms. In patients with lumbar disc herniation that improves with conservative treatment, the recurrence of symptoms should prompt a thorough review of the medical history, physical examination, and imaging studies to establish the diagnosis and prevent delay in treatment. |
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