Lomber diskojenik ağrıya neden olanspinal gaz birikimi: Olgu sunumu

Abstract

Vakum disk fenomeni, sıklıkla dejeneratif disk hastalıklarıyla birlikte görülen ve disk aralığında gaz birikimi ile karakterize bir durumdur. Disk aralığında gaz birikiminin klinik önemi olmasa da, spinal kanal içinde görüldüğünde klinik bulgulara yol açabilir. Çalışmamızda, kliniğimize başvurmadan önce 3 aydır bel ve sol bacak ağrısı olan 60 yaşındaki bir bayan hasta sunuyoruz. Hastanın sol bacak germe testi 50 derecede pozitifti. Manyetik rezonans görüntülemede vakum disk fenomeni ile birlikte L5-S1 disk aralığının daraldığı ve T1 ve T2 ağırlıklı görüntülerde hipointens kistik kitle görüldü. Hasta ameliyata alındı ve sol L5-S1’e hemilaminektomi ve foraminotomi uygulandı. Sinir kökü ve duraya yapışık olan kist duvarı kısmi olarak eksize edildi. Hasta ameliyat sonrası ilk günde ağrısızdı. Spinal kanalda gaz birikimi diskojenik ağrıya yol açabilir. Spinal kanalda gaz birikimi ile birlikte vakum disk fenomeninde cerrahi tedavi hala uygulanabilir bir yöntemdir.

Keywords

• Gaz birikimi; siyatik; spinal kanal; vakum fenomeni.

Spinal gas accumulation causing lumbar discogenic disease: a case report

Abstract

Vacuum disc phenomenon is seen frequently with degenerative disc disease and is characterized by the collection of gas in the disc space. Although the accumulation of gas within the disc space does not have clinical significance, symptoms may develop when occurring within the spinal canal. We present a 60-year-old female patient with low back and left leg pain occurring for 3 months before admission to our clinic. Straight leg raise test was 50 degrees in the left leg. Magnetic resonance imaging showed a narrowing of the L5-S1 disc space with vacuum disc phenomenon and hypointense cystic mass in T1 and T2-weighted images. The decision for surgery was made and left L5-S1 hemilaminectomy and foraminotomy was performed. The cyst wall was adherent to the root and dura mater and was partially excised. The patient was pain-free on the first postoperative day. In cases of gas accumulation in the spinal canal, discogenic pain may occur. Surgical therapy is still an acceptable method for the treatment of vacuum disc phenomenon and accumulation of gas within the spinal canal.

Keywords

• Gas accumulation
• sciatica
• spinal canal
• vacuum phenomenon

References

1. Tamburrelli F, Leone A, Pitta L. A rare cause of lum- bar radiculopathy: spinal gas collection. J Spinal Disord 2000;13:451-4.
2. Yoshida H, Shinomiya K, Nakai O, Kurosa Y, Yamaura I. Lumbar nerve root compression caused by lumbar intra- spinal gas. Report of three cases. Spine (Phila Pa 1976) 1997;22:348-51.
3. Ozgen S, Konya D, Toktas OZ, Dagcinar A, Ozek MM. Lumbar disc herniation in adolescence. Pediatr Neurosurg 2007;43:77-81.
4. Kakitsubata Y, Theodorou SJ, Theodorou DJ, Yuko M, Ito Y, Yuki Y, et al. Symptomatic epidural gas cyst associated with discal vacuum phenomenon. Spine (Phila Pa 1976) 2009;34:784-9.
5. Mortensen WW, Thorne RP, Donaldson WF 3rd. Symp- tomatic gas-containing disc herniation. Report of four cases. Spine (Phila Pa 1976) 1991;16:190-2.
6. Pierpaolo L, Luciano M, Fabrizio P, Paolo M. Gas-con- taining lumbar disc herniation. A case report and review of the literature. Spine (Phila Pa 1976) 1993;18:2533-6.
7. Berns DH, Ross JS, Kormos D, Modic MT. The spinal vacuum phenomenon: evaluation by gradient echo MR imaging. J Comput Assist Tomogr 1991;15:233-6.
8. Coulier B. The spectrum of vacuum phenomenon and gas in spine. JBR-BTR 2004;87:9-16.

9. Norman ER, Beall DP, Kitley CA, Ly JQ. Interverte- bral disk cyst: a case report. J Comput Assist Tomogr 2006;30:313-5.
10. Bosser V, Dietemann JL, Warter JM, Granel de Solignac M, Beaujeux R, Buchheit F. L5 radicular pain related to lumbar extradural gas-containing pseudocyst. Role of CT-guided aspiration. Neuroradiology 1990;31:552-3.