転移性脊椎腫瘍との鑑別を要した多発性圧迫骨折の1例

Compression Fracture Requiring Differentiation from Metastatic Spinal Tumors. Case Report

　59歳，男性の多発性脊椎圧迫骨折の1例を報告する．患者は特に誘因なく激しい背部痛を訴えた．神経学的異常所見はなかった．単純X線像では多発性胸椎圧迫骨折を認めた．MRIにて胸椎，腰椎にT1強調像，T2強調像ともに低信号を示す領域がみられた．腫瘍マーカーおよび内科的全身検索にて異常は認めなかった．骨生検では造血細胞が大半を占めており，悪性疾患は否定された．疼痛管理にモルヒネを使用し，徐々に改善傾向を認め，5カ月後に疼痛はほぼ消失した．MRI所見は不均一に分布する赤色髄と考察した．

　We report the case of a 59-year-old man with multiple vertebral compression fractures. He initially complained of severe back pain in the absence of any traumatic event. Examination revealed no abnormal neurological findings. Roentgenograms revealed multiple compression fractures of the thoracic vertebrae, and both T1 and T2-weighted MRI showed multiple low signal areas throughout the spine. Systemic examinations and tumor marker analyses yielded no abnormal findings. A biopsy specimen of a vertebra revealed hematopoietic cells but no evidence of malignancy. We used morphine for pain control, and the back pain gradually decreased and had almost disappeared 5 months later. We concluded that the MRI findings reflected heterogeneous distribution of red bone marrow in the vertebrae.