Baastrup棘间囊囊肿的硬膜外后延伸引起的神经源性跛行很少见。手术减压是治疗的金标准。此病例报告描述了成功的经皮治疗,并具有良好的早期临床放射效果。
本研究旨在描述经皮成功治疗导致神经源性跛行的中央后硬膜外Baastrup囊肿。
这是一个案例报告研究。
一名62岁男子出现神经源性跛行,其背景是既往接受化疗的淋巴瘤,慢性阻塞性肺疾病,慢性静脉功能不全,和肥胖。麻醉镇痛的保守治疗失败了,新要求的助行器和显著减少步行距离。磁共振成像证实Baastrup棘间囊囊肿的中央后硬膜外延伸导致严重的L3-L4管狭窄。在有意识的镇静下,最初的经皮计算机断层扫描(CT)引导的棘间穿刺造影间接使囊肿浑浊,并促进了经椎板直接进入硬膜外囊肿。在针头开窗和硬膜外类固醇注射之前进行抽吸。
六周的回顾显示疼痛和活动能力有了显著改善,不需要镇痛或助行器,并恢复患者的基线步行距离。3个月时,重复磁共振成像(MRI)证实,作为治疗效果的中介,囊肿大小显着减少。在24个月的随访中,背部和腿部症状的改善是持久的。
在选定的情况下,作为Baastrup现象的一部分,经皮治疗有症状的中央后硬膜外囊肿可能是可行的。这种治疗方法避免了全身麻醉,避免了手术减压的程序风险,在门诊进行,具有良好的早期临床放射效果。对于不良手术候选人的患者,这可能是一种保留手术的选择,也可能是继续保守治疗的替代方法。
Neurogenic claudication from posterior epidural extension of a Baastrup interspinous bursal cyst is rare. Surgical decompression is the gold standard of treatment. This case report describes successful percutaneous treatment with good early clinicoradiological outcome.
This study aimed to describe the successful percutaneous treatment of a central posterior epidural Baastrup cyst causing neurogenic claudication.
This is a case report study.
A 62-year-old man presented with neurogenic claudication on a background of previous lymphoma treated with chemotherapy, chronic obstructive pulmonary disease, chronic venous insufficiency, and obesity. Conservative therapy with narcotic analgesia had failed, with new requirement of a walking aid and marked reduction in walking distance. Magnetic resonance imaging confirmed severe L3-L4 canal stenosis from central posterior epidural extension of a Baastrup interspinous bursal cyst. Under conscious sedation, initial percutaneous computed tomography (CT)-guided interspinous bursography indirectly opacified the cyst and facilitated trans-laminar direct needle access to the epidural cyst. Aspiration was performed before needle fenestration and epidural steroid injection.
Six-week review revealed significant improvement in pain and mobility, with no analgesic or walking aid requirement, and restoration of the patient\'s baseline walking distance. At 3 months, repeat magnetic resonance imaging (MRI) confirmed significant reduction in cyst size as the mediator of the treatment effect. Improvement in back and leg symptoms was durable at 24-month follow-up.
In selected cases, percutaneous treatment of symptomatic central posterior epidural cysts as part of Baastrup phenomena may be feasible. This treatment approach avoided general anesthesia, avoided the procedural risks of surgical decompression, and was performed in the outpatient setting, with good early clinicoradiological outcome. This may emerge to be a surgical sparing option or an alternate to continuing conservative therapy in patients who are poor surgical candidates.