歩行により誘発される便失禁を呈した頸椎椎間板ヘルニアの1例—脊髄性間欠性直腸障害について

A Case Report of Cervical Disc Hernia Presenting Fecal Incontinence Evoked by Walking; Spinal intermittent rectal dysfunction

I．はじめに

　通常，何らかの脊柱管内空間占拠性病変による神経症状は，患者の姿勢や動作にかかわらず認めることが多いが，一方，姿勢の変化により症状が増強することもよく知られており，例えば，頸椎病変では，頸の過伸展や過屈曲により増強することは，しばしば遭遇するところである．また歩行動作により神経症状が誘発されることもあり，脊髄馬尾病変による神経原性間欠性跛行は，その代表的なものである．最近では，胸髄性，頸髄性病変による間欠性跛行の症例もいくつか発表されている．

　われわれは，後縦靱帯骨化症（Ossification of Poste—rior Longitudinal Ligament，以下OPLL）に合併した頸椎椎間板ヘルニアの症例で，歩行により誘発される便失禁を呈し，前方除圧固定術により，間欠性直腸障害の消失を確認できた1例を経験した．頸髄病変により，間欠性直腸障害を呈した症例は，われわれの調べ得た限りでは今までに報告されていない．この特異な症例につき報告し，頸髄病変による間欠性直腸障害の機序につき検討した．

Intermittent clinical manifestations, the representative one of which is claudication, can be classified into two types; neurogenic and vasculogenic.

Although cauda equina lesions are well known as a neurogenic cause, spinal disorders, especially cervical or thoracic cord lesions, have been paid more attention to by several authors recently. We encountered a 42-year-old man with cervical soft disc hernia and ossification of longitudinal ligament, who showed intermittent rec-tal dysfunction evoked by walking. This peculiar clinic-al manifestation successfully disappeared after surgical decompression of the spinal cord. Such an interesting case has not been reported in the world literature. The patient was admitted because of numbness in both hands. Neurological examinations on admission showed neither motor weakness nor abnormally in-creased tendon reflex. Hypesthesia and hypalgesia were noticed below the Th4 dermatome on both sides. Adding to those symptoms, he complained of fecal in-continence evoked by walking 100 meters. This rectal dysfunction became gradually worse. At last he showed fecal incontinence after walking only 10 meters. This was ten clays after his admission. Myelogram and com-puted tomographic scan revealed a cervical soft disc hernia at the C5/6 level and findings of °PIA, at the C5 and C6 level. Anterior cervical approach for OPLI, and soft disc was used for bone graft insertion from the C4 to the C7 vertebral body. The rectal dysfunction completely disappeared after the operation. The possible mechanisms of intermittent rectal dys-function evoked by walking were discussed.