Abstract：
UNASSIGNED: To report the first case of hyperacute onset of adjacent segmental disease (ASD) with dorsally migrated herniated nucleus pulposus (HNP) causing cauda equina syndrome.
UNASSIGNED: A 55-year-old female complained of lower back pain with radiating pain in both lower extremities that had not responded to conservative treatment over the previous six months. Plain radiographs and magnetic resonance imaging (MRI) findings revealed degenerative spondylolisthesis with spinal stenosis at L3-4, L4-5, and a slight bulging disc at L2-3. The patient underwent decompressive total laminectomy and posterior fusion at L3-4 and L4-5. The stenotic symptoms improved significantly after surgery, and she was then discharged on postoperative day 7.
UNASSIGNED: However, the patient visited the emergency department four days after discharge (postoperative day 11) complaining of sudden onset of bilateral lower extremity weakness and voiding and defecation difficulties. The follow-up MRI showed dorsally migrated huge HNP and a detached posterior longitudinal ligament (PLL) at L2-3, which was diagnosed as hyperacute onset of ASD causing cauda equina syndrome. The patient underwent an emergency second operation consisting of partial laminectomy at L2-3 with removal of the dorsally migrated huge HNP. After the second operation, the symptoms of cauda equina syndrome improved. One year after the second operation, the patient is doing well without recurrence of symptoms.
UNASSIGNED: Our case showed that hyperacute onset of ASD with dorsally migrated huge HNP can cause cauda equina syndrome, even within 2 weeks after lumbar fusion surgery. Therefore, a high index of suspicion, timely diagnosis, and surgical treatment are needed to avoid the catastrophic neurologic complications in similar extremely rare cases.
UNASSIGNED: A 55-year-old female complained of lower back pain with radiating pain in both lower extremities that had not responded to conservative treatment over the previous six months. Plain radiographs and magnetic resonance imaging (MRI) findings revealed degenerative spondylolisthesis with spinal stenosis at L3-4, L4-5, and a slight bulging disc at L2-3. The patient underwent decompressive total laminectomy and posterior fusion at L3-4 and L4-5. The stenotic symptoms improved significantly after surgery, and she was then discharged on postoperative day 7.
UNASSIGNED: However, the patient visited the emergency department four days after discharge (postoperative day 11) complaining of sudden onset of bilateral lower extremity weakness and voiding and defecation difficulties. The follow-up MRI showed dorsally migrated huge HNP and a detached posterior longitudinal ligament (PLL) at L2-3, which was diagnosed as hyperacute onset of ASD causing cauda equina syndrome. The patient underwent an emergency second operation consisting of partial laminectomy at L2-3 with removal of the dorsally migrated huge HNP. After the second operation, the symptoms of cauda equina syndrome improved. One year after the second operation, the patient is doing well without recurrence of symptoms.
UNASSIGNED: Our case showed that hyperacute onset of ASD with dorsally migrated huge HNP can cause cauda equina syndrome, even within 2 weeks after lumbar fusion surgery. Therefore, a high index of suspicion, timely diagnosis, and surgical treatment are needed to avoid the catastrophic neurologic complications in similar extremely rare cases.
摘要：
目的：报道首例邻近节段性疾病（ASD）伴有背侧迁移的髓核疝（HNP）引起马尾神经综合征的超急性发作病例。
方法：一名55岁女性主诉腰痛，双下肢放射状疼痛，过去6个月对保守治疗无反应。X线平片和磁共振成像（MRI）发现，退行性腰椎滑脱伴L3-4，L4-5的椎管狭窄，L2-3的椎间盘轻微膨出。患者在L3-4和L4-5接受了全椎板减压切除术和后路融合。术后狭窄症状明显改善,然后她在术后第7天出院。
结果：然而，患者出院后4天（术后第11天）到急诊科就诊，抱怨突然出现双侧下肢无力，排尿和排便困难。随访MRI显示背侧迁移的巨大HNP和L2-3处的后纵韧带（PLL）脱离，被诊断为ASD的超急性发作导致马尾综合症。患者接受了紧急第二次手术，包括L2-3的部分椎板切除术，并切除了背侧迁移的巨大HNP。第二次手术后，马尾综合症的症状有所改善。第二次手术一年后,病人情况良好，没有复发症状。
结论：我们的病例表明，ASD的超急性发作伴有背侧迁移的巨大HNP可引起马尾综合征，甚至在腰椎融合术后2周内。因此,高度怀疑，及时诊断,在类似的极其罕见的病例中，需要手术治疗以避免灾难性的神经系统并发症。
方法：一名55岁女性主诉腰痛，双下肢放射状疼痛，过去6个月对保守治疗无反应。X线平片和磁共振成像（MRI）发现，退行性腰椎滑脱伴L3-4，L4-5的椎管狭窄，L2-3的椎间盘轻微膨出。患者在L3-4和L4-5接受了全椎板减压切除术和后路融合。术后狭窄症状明显改善,然后她在术后第7天出院。
结果：然而，患者出院后4天（术后第11天）到急诊科就诊，抱怨突然出现双侧下肢无力，排尿和排便困难。随访MRI显示背侧迁移的巨大HNP和L2-3处的后纵韧带（PLL）脱离，被诊断为ASD的超急性发作导致马尾综合症。患者接受了紧急第二次手术，包括L2-3的部分椎板切除术，并切除了背侧迁移的巨大HNP。第二次手术后，马尾综合症的症状有所改善。第二次手术一年后,病人情况良好，没有复发症状。
结论：我们的病例表明，ASD的超急性发作伴有背侧迁移的巨大HNP可引起马尾综合征，甚至在腰椎融合术后2周内。因此,高度怀疑，及时诊断,在类似的极其罕见的病例中，需要手术治疗以避免灾难性的神经系统并发症。
