Most people with low back and leg pain are diagnosed with common diseases such as lumbar disc herniation or lumbar spondylolisthesis. I recently saw a "leg so painful that I couldn't walk" that was considered a lumbar spondylolisthesis in many hospitals, and it turned out to be a rare disease with a incidence of only 1 in 1 million - spontaneous epidural hematoma.
The patient, Aunt Zhao (pseudonym), is 73 years old and has always been healthy, but has a history of long-term hypertension.
"I usually take a medicine to control my blood pressure, and I don't feel uncomfortable. Aunt Zhao said.
12 days before she was admitted to the hospital, Aunt Zhao suddenly developed symptoms of leg pain.
"Pain in the front of the thigh!"
"It hurts so much when I walk!"
The wife, Uncle Zhang (pseudonym), and Ms. Zhang saw that Aunt Zhao's leg pain was not relieved for 3 days, so they went to a hospital for treatment. As a result, he was diagnosed with "spondylolisthesis" and surgery was recommended. Ms. Zhang was not worried and took her mother to several hospitals in Xi'an, and all of them recommended surgical intervention.
"Since you are going to have surgery, it is better to go to the 'Centennial Red Cross' to have a look," Ms. Zhang decided to come to my clinic after looking up information on the Internet.
At this time, Aunt Zhao's leg pain has developed to the point that she can't walk!
Judging from Aunt Zhao's video data, I did see a slight slippage on my waist 4-5. However, diagnosis of spinal disorders requires a combination of history, symptoms, signs, and imaging data.
Although Aunt Zhao had lumbar spondylolisthesis on the image, the symptoms did not match the image, and there were no sciatica symptoms, but bone nerve compression symptoms - pain in the front of the thigh. If the symptoms do not match the images, there is no way to talk about treatment.
From Aunt Zhao's lumbar spine MRI, it can be seen that there is an abnormality in waist 1-2, similar to a tumor. However, combined with Aunt Zhao's long-term history of hypertension and long-term use of reserpine, there is a high suspicion of spontaneous epidural hematoma.
Popular science: spontaneous epidural hematoma
Spontaneous epidural hematomas have a prevalence of approximately 1 in a million and are characterized by acute onset of neck or back pain with rapidly progressive nerve root or spinal cord compression, and in severe cases can progress to total paralysis.
Spontaneous spinal epidural hematomas can present with severe spinal cord or neurologic deficits within hours or days, but clinicians are not well aware of the disease and are prone to miss the best time for treatment.
Treatment of spontaneous epidural hematoma is focused on hematoma removal to avoid worsening neurologic impairment. Traditional surgical methods require internal fixation to maintain the biomechanical stability of the lumbar spine, but Aunt Zhao also has osteoporosis, and the nail rod fixation system is easy to loosen.
According to Aunt Zhao's condition, we have formulated a plan to develop a bilateral spinal decompression surgery (ULBD) with endoscopic unilateral lamina approach - not only to remove the hematoma, but also to achieve the same treatment effect as traditional surgery with a minimally invasive surgery with an incision of less than 1 cm!
After controlling Aunt Zhao's blood pressure to an appropriate range, we urgently completed the operation to avoid the further development of the hematoma leading to paralysis and other neurological dysfunction that is difficult to recover.
The surgery was very successful, and Aunt Zhao was able to walk normally the day after surgery!
"It doesn't hurt at all!" Aunt Zhao's family "praised" Xi'an Honghui Hospital's superb surgical skills and high-level medical service capabilities when they were discharged from the hospital!
Remind:
Hypertension can induce spontaneous epidural hemorrhage and hematoma formation. Therefore, patients with high blood pressure must control their blood pressure scientifically, and they must seek medical attention in time after having suspected symptoms to avoid neurological dysfunction that is difficult to improve!