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A Case of Thoracic Disc Herniation Extruded to the Dorsal Epidural Space

Open Journal of Orthopedics 2015年第8期5卷 229-234页

作者： shigeta takeuchi Yuichirou Yokoyama Yasuaki Iida Keiji Hasegawa Akihito Wada Ryoichi Fukano Kazutoshi Shibiuya Hiroshi Takahashi Department of Orthopaedic Surgery Toho University School of Medicine Tokyo Japan Department of Pathology Toho University School of Medicine Tokyo Japan

We encountered a patient with thoracic disc herniation that extruded to the dorsal epidural space. The patient was a 78-year-old man in whom listlessness of the lower limbs developed without an inducer and walking became difficult. The patient was diagnosed as having a thoracic spinal cord tumor on MRI by a physician, and was referred to our hospital. Since ring enhancement was observed on contrast MRI performed at our hospital, the patient was diagnosed with disc herniation and surgery was performed. A hernia continuous with the intervertebral space that extruded to the dorsal epidural space was excised. At the final follow up, 1 year and 4 months after surgery, the patient could walk with a cane. Among thoracic disc herniation cases, hernia extruded to the dorsal epidural space is rare and difficult to diagnose by imaging before surgery, but evaluation using contrast MRI is useful in the diagnosis. When a space-occupying lesion is observed in the spinal canal in the lower thoracic spinal region, it is necessary to evaluate it by contrast MRI in consideration of thoracic disc herniation.

关键词： Disc Hernia Dorsal Epidural Space Thoracic Spine

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Spinal Epidural Cavernous Hemangioma of the Thoracic Spine: A Case Report

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Open Journal of Orthopedics 2015年第10期5卷 311-318页

作者： Ryoichi Fukano Yasuaki Iida Keiji Hasegawa Yuichirou Yokoyama Akihito Wada shigeta takeuchi Kazutoshi Shibuya Hiroshi Takahashi Department of Orthopaedic Surgery Toho University School of Medicine Tokyo Japan Department of Pathology Toho University School of Medicine Tokyo Japan

Cavernous hemangiomas can arise in any region of the body, including the central nervous system. Spinal cavernous hemangiomas account for 5% - 12% of all cases of vertebral vascular malformation. Most of these are of vertebral origin, and cases that are non-vertebral in origin are rare. We encountered a patient with a relatively rare spinal epidural cavernous hemangioma of the thoracic spine that was non-vertebral in origin. The patient was a 63-year-old man. He had become aware of bilateral leg pain and numbness about 2 months earlier, and gait disturbance appeared gradually thereafter. On MRI, a lesion showing iso-intensity on T1-weighted imaging and high intensity on T2-weighted imaging was detected at the 7th thoracic vertebra. On gadolinium contrast-imaging, the lesion was found to be a homogenously-enhanced dumbbell-shaped extradural spinal neoplasm protruding from the left 7th/8th thoracic intervertebral foramen. A neurogenic tumor was suspected based on myelography and MRI findings, and complete tumorectomy was performed, which improved the lower limb symptoms and gait disturbance. The histopathological diagnosis was cavernous hemangioma. Epidural hemangiomas arise from the vertebra in many cases, and pure spinal epidural cavernous hemangiomas are rare. It is difficult to make a preoperative diagnosis because there are no specific imaging findings that can differentiate these tumors. It may be important to consider this disease before surgery in the differential diagnosis of epidural tumors.

关键词： Epidural Cavernous Hemangioma Thoracic Spine Myelopathy

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