不典型腰椎间盘突出马尾综合征的误诊分析

Misdiagnosis of Cauda Equina Syndrome Secondary to Lumbar Disc Herniation

目的:对继发于腰椎间盘突出的马尾综合征的误诊原因进行分析。方法:对本院收治的4例继发于腰椎间盘突出的马尾综合征的误诊病例的症状、体征、影像学表现、手术、随访结果进行研究分析。结果:本组手术无手术并发症,但术后患者的症状恢复较慢,甚至随访时仍有部分症状残留。结论:造成腰椎问盘突出马尾综合征误诊的主要原因为发病时缺少典型的腰腿痛症状以及缺少对会阴部感觉的详细检查,对于继发椎间盘突出的马尾综合征,只要通过详细的询问病史和体格检查,结合CT、MRI等影像学检查,早期诊断是不困难的。一旦诊断,就应立即手术。延迟手术明显影响疗效,甚至残留永久性的神经损害。

Objective: To analyze the cause of misdiagnosis of cauda equina syndrome (CES) secondary to lumbar disc herniation. Methods: Four patients with CES from lumbar disc herniation were retrospectively reviewed in this study. All patients were delayed in diagnosis and treatment in other hospitals, they were managed surgically with larninectomy or hernil-aminectomy and discectomy by current author. The clinical data including history, symptoms, signs, radiograph, treatment and follow-ups were collected to analyze the cause and the effect of misdiagnosis of this emergent entity. Results: No neurological deterioration occurred postoperatively. The recovery of neurological deficit was slow and the residual urinary dysfunction persisted at the nearest follow-ups in two patients. Conclusion: The reasons for the failure of early diagnosis include lack of the typical radicular pain and detailed perineal examination. Delayed surgeries significantly affect the surgery results and may left permanent neurological deficit.