成人の脊髄性脳震盪。垂直荷重を受けた脊髄の一過性神経麻痺について

Spinal Concussion in Adults: Transient Neuropraxia of Spinal Cord Exposed to Vertical Forces.

抄録

研究の目的:

本研究の目的は、脊椎が垂直方向の力にさらされた後、一過性の脊髄衝撃の症状を呈した症例と脊髄震盪の症例の外傷後の臨床経過について、文献的知見とともに考察することである。

OBJECTIVE: The aim of the study is to discuss along with literature knowledge the post-traumatic clinical progression of cases with symptoms of transient spinal cord impact and cases of spinal concussion following exposure of the vertebral column to vertical forces.

材料と方法:

全43例、すべて高所からの転落で、脊髄震盪と診断された。脊椎が垂直方向の力の影響を受けたと判断された。すべての症例において、入院時に脊髄磁気共鳴画像検査と動的X線検査が実施された。症例の臨床症状はTorg Grading Systemに基づくスコアリングによって記録された。

MATERIALS AND METHODS: A total of 43 cases, all falls from height, were diagnosed with spinal concussion. It was determined that the vertebral column had been exposed to the effects of vertical forces, and the spinal cord had been affected by vertical forces. In all cases, spinal magnetic resonance imaging and dynamic X-ray examinations were performed at the time of admission. Clinical symptoms of the cases were recorded by scoring based on the Torg Grading System.

結果:

症例は、臨床症状を説明するX線学的症状が検出されなかったため、保存的治療が開始された。最も多く見られたのは、上部胸椎と下部頸椎の神経症状であった。7例では尿失禁も検出された。脊髄に関連する症状は，全例1～3日で完全に回復した．

RESULTS: Cases were started on conservative treatment because radiologic symptoms that would explain the clinical symptoms could not be detected. Most frequently encountered were the neurologic symptoms related to the upper thoracic and lower cervical segments being affected. In 7 cases, urinary incontinence was also detected. Symptoms related to the spinal cord being affected were completely recovered in 1-3 days in all cases.

結論:

脊椎が垂直方向の力によって影響を受ける結果、最も頻繁に影響を受けるのは脊髄の胸椎セグメントである。これらの症例は、臨床症状やX線学的症状とともに評価すると、X線学的異常のない本物の脊髄損傷症例と類似していることがわかる。X線写真の異常がない本物の脊髄損傷例との絶対的な鑑別診断は、神経学的な全回復が行われるまで行うことはできない。

CONCLUSION: As a result of the vertebral column being affected by vertical forces, the most frequently affected are the thoracic segments of the spinal cord. These cases show similarities to real spinal cord injury without radiographic abnormality cases when evaluated along with clinical and radiologic symptoms. Absolute differential diagnosis from real spinal cord injury without radiographic abnormality cases cannot be made until total neurologic recovery takes place.