潜在性二分脊椎に発生した成人発症型tethered cord syndromeの1例

Tethered Cord Syndrome with Occult Spinal Dysraphism : Case Report

　抄録：症例は54歳，女性，誘因なく両下肢麻痺を来した．腰仙部に軽度の膨隆と画像にて二分脊椎が認められた．右下肢の完全麻痺，膀胱直腸障害，前屈位で下肢放散痛の増強があり，潜在性二分脊椎に伴うspinal lipomaによる脊髄・馬尾係留症状であると診断した．Tethered cord syndromeに対して，係留解除を目的にlipomaの可及的摘出と馬尾の癒着剝離，脊髄終糸の切離を施行し，術後麻痺の改善が得られた．二分脊椎に合併した脊髄病変の診断と術後良好な結果を得たので，若干の文献的考察を加え報告する．

　We report a case of tethered cord syndrome with occult spinal dysraphism. The patient was a 54-year-old female who complained of the sudden onset of pain, sensory disturbance, and motor weakness in her legs with bladder and rectal disturbances. Radiation of the pain in her legs was aggravated by flexion of the spine. Radiography showed spinal dysraphism, and magnetic resonance imaging (MRI) revealed that the conus was low, at the level of L5. Based on a preoperative diagnosis of tethered cord syndrome, we detached a spinal lipoma as much as possible, released the tethered cord surgically, and reconstructed the subarachnoid space with a Gore-Tex^® surgical membrane. The motor weakness in the legs and bladder and rectum disturbances were improved postoperatively.