椎管内肿瘤误诊为腰椎间盘突出症临床分析

Clinical Analysis of Intraspinal Tumors Misdiagnosed as Lumbar Disc Herniation

目的探讨椎管内肿瘤的临床特点,分析误诊原因,总结防范误诊措施,以提高临床医师的诊治水平。方法回顾性分析椎管内肿瘤误诊为腰椎间盘突出症2例的临床资料。结果1例因腰痛伴左下肢疼痛麻木3个月,右下肢疼痛麻木1个月入院,病初诊断为腰椎间盘突出症,给予对症治疗后症状无明显好转,进一步行胸椎MRI检查示胸椎椎管内肿瘤并行手术治疗,术后病理检查证实为良性胸椎椎管内肿瘤,术后1个月腰痛伴双下肢疼痛麻木症状消失,随访至今病情未复发。1例因腰痛及右下肢疼痛麻木1年,加重2周入院,影像学检查支持腰椎间盘突出症诊断,遂行手术治疗,术中发现第4~5腰椎椎间隙右侧有一占位性病变向后突向椎管腔并压迫硬膜囊和神经根,经术后病理检查及颈部CT和放射性核素检查最终确诊为甲状腺癌椎管内转移,行甲状腺次全切除术及放疗,治疗半年患者死亡。结论临床遇及腰痛、下肢疼痛、麻木等症状类似腰椎间盘突出症且给予对症处理症状未见好转的患者时,应考虑到椎管内肿瘤的可能,认真分析病情、详细询问病史、仔细鉴别诊断、开拓诊断思维、及时行MRI检查可避免误诊。

Objective To investigate the clinical characteristics of intraspinal tumors,to analyze the causes of misdiagnosis,and to summarize preventive measures so as to improve the skills of clinicians in diagnosis and treatment.Methods The clinical data of two cases of intraspinal tumors misdiagnosed as lumbar disc herniation(LDH)in our hospital were analyzed retrospectively.Results One case was admitted to our hospital with low back pain accompanied by pain and numbness of left lower extremity for 3 months as well as referred pain and numbness of right lower extremity for 1 month.At the beginning of the disease,it was diagnosed as LDH.After the symptomatic treatment,the symptoms did not improve significantly.Further MRI examination of the thoracic spine showed the tumor in the thoracic spinal canal,and surgical intervention was performed.The tumor was confirmed to be benign by postoperative pathological examination.One month after the operation,lower back pain accompanied by referred pain and numbness of both lower extremities disappeared and had not recurred since the follow-up.One case was hospitalized for lower back pain and pain and numbness of right lower extremity for 1 year that was aggravated for 2 weeks.Multiple imaging examinations supported the diagnosis of LDH,and surgical treatment was carried out.During the operation,a space occupying lesion on the right side of the fourth to fifth lumbar intervertebral space protruded backward to the vertebral canal cavity to compress the dural sac and nerve root.The final diagnosis of intraspinal metastasis of thyroid cancer was confirmed by postoperative pathological examination,neck CT and radionuclide examination.Subtotal thyroidectomy and radiotherapy were performed.The patient died after treatment for half a year.Conclusion When the clinical symptoms such as lower back pain,lower extremity pain and numbness are similar to LDH,and when symptoms are not improved after symptomatic treatment,the possibility of intraspinal tumor should be considered.Careful analysis of the condition,detailed inquiry of the history,careful differential diagnosis,open diagnostic thinking and timely MRI examination can avoid misdiagnosis.