椎体scallopingを呈した腰椎椎間板ヘルニアの1例

Lumbar Disc Herniation with Vertebral Scalloping. Case Report

　腰椎椎間板ヘルニアに椎体scallopingを伴った症例を経験した．症例は66歳の女性で，1カ月前からの左下肢の疼痛としびれを主訴に来院した．CTおよびMRIにてL5椎体後方および左椎弓にscallopingを認めた．術中所見にて硬い軟骨性の腫隆が椎体の後方左椎弓の直下に存在し，L5神経根を後尾側に圧迫していた．病理診断は変性した椎間板であった．患者は術後より疼痛は軽減した．椎間板ヘルニアは椎体にscallopingを来たす原因としては稀であるものの，腰椎にscallopingを来している症例では神経鞘腫との鑑別が必要である．

　A case report of lumbar disc herniation presenting with vertebral scalloping is described. A 66-year-old woman complained of pain and hyperesthesia in her left buttock and leg lasting for one month. Computed tomography and magnetic resonance imaging studies revealed scalloping of the posterior wall and left pedicle of the L5 vertebra. Intraoperatively, a hard cartilaginous mass was found posterior to the L5 vertebral body, just below the left pedicle；the mass was compressing the L5 nerve root in the caudal and posterior directions. A pathological concluded that the mass was a degenerated intervertebral disc. The patients pain was immediately relieved after surgery. Although rare, disc herniation should be differentiated from neurogenic tumors as a cause of lumbar vertebral scalloping.