皮膚サルコイドーシスを合併した髄内浮腫を伴う頚髄症の1例

Cervical Spinal Stenosis with Sarcoidosis Treated by Steroid Pulse Therapy and laminoplasty : Case Report

　抄録：症例は64歳，女性．巧緻運動障害，歩行障害を主訴に来院．左眼内側発赤部皮膚生検によりサルコイドーシスと確定診断されていた．MRI，CTMにてC 3-5での硬膜管の著明な圧排，同部の脊髄内信号変化を認めた．脊髄サルコイドーシスを疑いステロイド投与するも効果なく頚椎椎弓形成術を施行し症状の軽快を認めた．本症例は，皮膚サルコイドーシスに髄内浮腫を伴う頚髄症を併発した興味深い症例であると思われ報告した．

　We report a rare case of cervical spondylotic myelopathy and spinal sarcoidosis that was successfully treated by steroid pulse therapy and laminoplasty. A 64-year-old woman was referred to our clinic because of a gait disorder. Sarcoidosis was diagnosed based on examination of a skin biopsy specimen obtained from an eyelid. The neurological examination revealed typical cervical myelopathy with exaggerated deep tendon reflexes and impaired motor and sensory function. The JOA score for the cervical myelopathy was 8/17. Magnetic resonance imaging of the cervical spine revealed spondylotic spinal canal stenosis and diffuse swelling of the spinal cord at the C4-6 levels, which were low signal intensity on the T1 weighted images and high signal intensity on the T2 weighted images. Since spinal sarcoidosis was suspected initially, we performed steroid pulse therapy. Although it was effective in improving the patient's symptoms for a few months, they recurred, and we performed laminoplasty. Postoperatively, the patient's symptoms were improved, and the JOA score increased to 12/17. Based on these clinical findings and the patient's course, we concluded that this was a case of spinal sarcoidosis associated with cervical spondylotic myelopathy not of spinal sarcoidosis alone.