Abstract：
BACKGROUND: This case report documents a postoperative, incomplete sensorimotor paraparesis from thoracic vertebral body 6 (Th6) after combined anesthesia for upper abdominal surgery in a patient who had a thoracic localization of spinal epidural lipomatosis (SEL).
METHODS: The patient was treated in our clinic with a thoracic epidural catheter (TEA) for perioperative analgesia during a partial duodenopancreatectomy. Paraparetic symptoms occurred 20 hours after surgery. Initial MRI did not show bleeding, infection or spinal cord damage and the neurosurgeon consultants recommended observation. The neurological examination and the third follow-up MRI on 15th postoperative day showed ventrolateral damage of the spinal cord at level Th6. It is possible that local anesthetic compressed the spinal cord in addition to the existing lipomatosis and the thoracic kyphosis. The paraparesis improved during follow-up paraplegiologic treatment.
CONCLUSIONS: So far, only two uncomplicated lumbar epidural catheter anesthesias have been described in patients who had a lumbar SEL. Epidural catheter anesthesia is a safe and effective method of pain control. But it is important to carefully identify and stratify patients with risk factors during the premedication visit. In patients who had kyphosis and thoracic localization of SEL, TEA may only be used after a risk-benefit assessment.
METHODS: The patient was treated in our clinic with a thoracic epidural catheter (TEA) for perioperative analgesia during a partial duodenopancreatectomy. Paraparetic symptoms occurred 20 hours after surgery. Initial MRI did not show bleeding, infection or spinal cord damage and the neurosurgeon consultants recommended observation. The neurological examination and the third follow-up MRI on 15th postoperative day showed ventrolateral damage of the spinal cord at level Th6. It is possible that local anesthetic compressed the spinal cord in addition to the existing lipomatosis and the thoracic kyphosis. The paraparesis improved during follow-up paraplegiologic treatment.
CONCLUSIONS: So far, only two uncomplicated lumbar epidural catheter anesthesias have been described in patients who had a lumbar SEL. Epidural catheter anesthesia is a safe and effective method of pain control. But it is important to carefully identify and stratify patients with risk factors during the premedication visit. In patients who had kyphosis and thoracic localization of SEL, TEA may only be used after a risk-benefit assessment.
摘要：
背景：此病例报告记录了术后，胸椎硬膜外脂肪瘤病（SEL）的患者在上腹部手术联合麻醉后，胸椎6（Th6）的不完全感觉运动性轻瘫。
方法：该患者在我们的诊所接受胸段硬膜外导管（TEA）治疗，用于十二指肠胰部分切除术的围手术期镇痛。手术后20小时出现异常症状。最初的MRI没有显示出血,感染或脊髓损伤和神经外科医生顾问建议观察。术后第15天的神经系统检查和第3次随访MRI显示Th6水平的脊髓腹外侧损伤。除了现有的脂肪瘤病和胸椎后凸畸形外，局部麻醉剂还可能压缩脊髓。截瘫治疗后，截瘫改善。
结论：到目前为止，在患有腰椎SEL的患者中，仅描述了两种简单的腰椎硬膜外导管麻醉。硬膜外导管麻醉是一种安全有效的疼痛控制方法。但重要的是要在术前就诊期间仔细识别和分层具有危险因素的患者。在患有后凸畸形和SEL胸部定位的患者中，TEA只能在风险收益评估后使用。
方法：该患者在我们的诊所接受胸段硬膜外导管（TEA）治疗，用于十二指肠胰部分切除术的围手术期镇痛。手术后20小时出现异常症状。最初的MRI没有显示出血,感染或脊髓损伤和神经外科医生顾问建议观察。术后第15天的神经系统检查和第3次随访MRI显示Th6水平的脊髓腹外侧损伤。除了现有的脂肪瘤病和胸椎后凸畸形外，局部麻醉剂还可能压缩脊髓。截瘫治疗后，截瘫改善。
结论：到目前为止，在患有腰椎SEL的患者中，仅描述了两种简单的腰椎硬膜外导管麻醉。硬膜外导管麻醉是一种安全有效的疼痛控制方法。但重要的是要在术前就诊期间仔细识别和分层具有危险因素的患者。在患有后凸畸形和SEL胸部定位的患者中，TEA只能在风险收益评估后使用。
