癫痫发作诱发非创伤性脊椎骨折临床分析

Clinical analysis of seizure-induced non-traumatic vertebral fractures

目的探讨癫痫发作诱发非创伤性脊椎骨折的临床特点,以提高临床医师对该病的认识。方法回顾性分析2020年1月至2023年1月首都医科大学附属北京天坛医院收治的癫痫发作诱发非创伤性脊椎骨折患者的临床资料。结果共发现4例癫痫发作致非创伤性脊椎骨折患者,均为男性,平均年龄为36.3岁。其中3例为上中胸椎多发压缩性骨折,1例为腰椎多发压缩性骨折。最常见的临床症状为局部疼痛,疼痛性质及部位均不典型。75%患者存在延迟诊断,仅1例患者骨折后行骨密度检测。保守或手术治疗后,所有患者均达到完全康复。结论癫痫发作诱发的非创伤性脊椎骨折好发于青中年男性,常见类型为胸腰椎压缩性骨折。此类特殊骨折的症状和体征不典型,容易漏诊、误诊。获取完整病史,进行全面检查包括脊椎影像学检查对该病诊断至关重要。控制癫痫发作是首要预防措施,慢性癫痫患者应考虑行骨密度检查,必要时可适当补充钙和维生素D预防骨折发生。

Objective To summarize the clinical features of seizure-induced non-traumatic vertebral fractures and improve their recognition.Methods Retrospective analysis was performed on the clinical data of patients who developed non-traumatic spinal fractures caused by seizure in Beijing Tiantan Hospital,Capital Medical University,from January 2020 to January 2023.Results In our retrospective analysis,we identified 4 patients who were diagnosed with non-traumatic vertebral fractures caused by seizure.Our patients were all males,with the average age of 36.3 years.In 3 of the cases,the multilevel vertebral compression fractures were located in the upper and midthoracic spine.There was only one instance of multilevel lumbar vertebral fractures.Local pain,with an atypical nature and scope,was the most common clinical symptom observed in these patients.In 75%of cases,the fracture diagnosis was missed at initial presentation.A bone density test was only performed on one patient at the time of the vertebral fracture occurred.Every patient experienced a complete recovery after conservative or surgical therapy.Conclusion Seizure-induced non-traumatic vertebral fractures occur predominantly in young and middle-aged males,and the common pattern is thoracolumbar compression fractures.The clinical symptoms and signs of this particular type of fractures are atypical,which is prone to misdiagnosis or missed diagnosis.A detailed history and examination,including spinal imaging,are important for the diagnosis of these patients.Controlling seizure is considered to be the main preventive method.Chronic epilepsy patients should be advised to get a bone density test and they should take calcium and vitamin D supplements,when necessary,for preventing the incidence of new vertebral fracture.