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Neurological Surgery No Shinkei Geka Volume 24, Issue 10 （October 1996）

Neurological Surgery 脳神経外科 24巻10号（1996年10月発行）

Japanese English

症例

多彩な脊椎病変を合併した末端肥大症の1例 A case of acromegaly associated with variegated spinal disorders 須賀俊博 ¹ , 村上栄一 ² , 石塚正人 ² , 方宇壽楠 ³ , 吉岡邦浩 ⁴ , 佐野光彦 ⁵ , 細矢貴亮 ⁶ Toshihiro SUGA ¹ , Eiichi MURAKAMI ² , Masato ISHIZUKA ² , Sou-Nan FANG ³ , Kunihiro YOSHIOKA ⁴ , Mitsuhiko SANO ⁵ , Takaaki HSOYA ⁶ ¹釜石市民病院脳神経外科 ²釜石市民病院整形外科 ³釜石市民病院内科 ⁴せいてつ記念病院放射線科 ⁵盛岡友愛病院神経内科 ⁶山形大学放射線科 ¹Department of Neurosurgery, Kamaishi Municipal Hospital ²Department of Orthopedics, Kamaishi Municipal Hospital ³Department of Internal Medicine, Kamaishi Municipal Hospital ⁴Department of Radiology, Seitetu Memorial Hospital ⁵Department of Neurology, Morioka Yuai Hospital ⁶Department of Radiology, Yamagata University School of Medicine キーワード： acromegaly , spinal disc herniation , spinal epidural cavernous angioma , ossification of yellow ligament , ossification of posterior longitudinal ligament , lumbar canal stenosis Keyword: acromegaly , spinal disc herniation , spinal epidural cavernous angioma , ossification of yellow ligament , ossification of posterior longitudinal ligament , lumbar canal stenosis pp.927-932

発行日 1996年10月10日 Published Date 1996/10/10

DOI https://doi.org/10.11477/mf.1436901285

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Abstract 文献概要
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I．はじめに

　末端肥大症や巨人症では，四肢の骨・関節病変とともに脊柱変形を呈しやすく，診断基準副症状の一つに数えられている^14）．脊椎骨の肥大や脊柱管内の軟部組織の肥大による脊柱管狭窄症もよく知られているが^3,9,15），椎間板ヘルニアや脊柱靱帯骨化症の合併は比較的少ない^1,2,10,16）．また，脊髄・脊椎の海綿状血管腫は，椎体骨よりの発生が大部分であり，硬膜外発生例は極めて稀である^5,7）．

　われわれは，頸椎椎間板ヘルニア，胸椎の黄色靱帯および後縦靱帯の骨化症および硬膜外発生の海綿状血管腫，腰椎狭窄症などの多彩な脊椎病変を呈した末端肥大症の1例を経験した．四肢麻痺と対麻痺を，短期間のうちに相次いできたし，手術により軽快したが，このような例は極めて稀である．文献的考察を加え，報告する．

A case of acromegaly associated with variegated spinal disorders was reported. The spinal disorders were multiple cervical disc herniations, spinal epidural cavernous angioma, multiple ossification of the spinal ligament and lumbar canal stenosis.

A 51-year-old woman with acromegaly, complaining of disturbances of delicate hand movement and gait, consulted our department. Her past history included di-abetes mellitus, hypertension and progressing enlarge-ment of her extremities. Serum growth hormone level was 65.7ng/ml and somatomedin-c level was 746ng/ml. Brain MRI showed a pituitary tumor extending to the right cavernous sinus. Cervical MRI revealed disc her-niations at C5/6 and C6/7. Thoracic MRI revealed osteoporosis, ossification of the posterior longitudinal ligament and multiple ossification of yellow ligament. Lumbar MRI disclosed ossification of yellow ligament and canal stenosis. Anterior fusion of C5-C7 and an intracapsular removal of the pituitary tumor were per-formed. Its pathology was that of eosinophilic adeno-ma. After 3 months, she suffered from paraparesis. On repeating MRI examination with Gd-DTPA, a spinal epidural mass was found at T4. Under laminectomy of Th3-5 and Th8-11, the epidural mass and ossified yellow ligament were removed. The epidural mass was cavernous angioma. She was able to walk without any assistance.

An association of spinal canal stenosis with acrome-galy is well known. But the association of disc hernia-tion and with the ossification of spinal ligaments is rather rare in the literature. Spinal epidural cavernous angioma is very rare. We discussed the etiologicalaspects and the management of spinal disorders with acromegaly.