Radiculopatia neoplásica lombossacral

Rossitti, Sandro L.; Roth-Vargas, Antonio A.; Sperlescu, Alexander; Balbo, Roque J.

doi:10.1590/S0004-282X1990000100014

Resumos

Comentário crítico da rotina radiodiagnóstica nas radiculopatias Iombossacrala no que concerne ao uso da tomografia computadorizada (CT). São relatadas as observações clínicas de três pacientes nos quais neoplasias acometeram uma única raiz lombossacral, simulando uma hérnia de disco lombar do ponto de vista clínico, com ênfase nos aspectos neurorradiológicos. Recomenda-se o estudo sistemático do sacro e da zona do cone medular em todo caso de radiculopatia lombossacral.

Lumbar-disc protrusions (LDP) constitute well-defined syndromes on clinical and anatomical grounds, and neurosurgeons are prone to rely upon the clinical signs to identify the level of disc protrusion when a «typical» case is found. Sometimes, non-contrasted computerized tomographic (CT) scans centered on the L5-S1, L4-L5 and L3-L4 interspaces and spine roentgenograms are the only special ancilary means in presurgical evaluation. We report three patients from our series, in which neoplasic spinal disease presented as classic LDP (one patient with a cauda equina schwannoma, and two with metastatic carcinoma). The cases were chosen because they posed special problems to the referred radiodiagnostic routine. Systematic CT-evaluation of the sacrum and conus medullaris zone is recommended in every patient with lumbosacral radiculopathy, and intratecal contrast should be employed in patients with unreliable findings or normal CT-scans.

Sandro L. Rossitti^I; Antonio A. Roth-Vargas^II; Alexander Sperlescu^III; Roque J. Balbo^IV

^IMédico Residente - Departamento de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP) e Departamento de Neurocirurgia do Hospital Vera Cruz (HVC), Campinas

^IINeurocirurgião do HVC - Departamento de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP) e Departamento de Neurocirurgia do Hospital Vera Cruz (HVC), Campinas

^IIIProfessor Assistente - Departamento de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP) e Departamento de Neurocirurgia do Hospital Vera Cruz (HVC), Campinas

^IVProfessor Adjunto, Diretor do Departamento de Neurocirurgia do HVC - Departamento de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP) e Departamento de Neurocirurgia do Hospital Vera Cruz (HVC), Campinas

RESUMO

Comentário crítico da rotina radiodiagnóstica nas radiculopatias Iombossacrala no que concerne ao uso da tomografia computadorizada (CT). São relatadas as observações clínicas de três pacientes nos quais neoplasias acometeram uma única raiz lombossacral, simulando uma hérnia de disco lombar do ponto de vista clínico, com ênfase nos aspectos neurorradiológicos. Recomenda-se o estudo sistemático do sacro e da zona do cone medular em todo caso de radiculopatia lombossacral.

SUMMARY

Lumbar-disc protrusions (LDP) constitute well-defined syndromes on clinical and anatomical grounds, and neurosurgeons are prone to rely upon the clinical signs to identify the level of disc protrusion when a «typical» case is found. Sometimes, non-contrasted computerized tomographic (CT) scans centered on the L5-S1, L4-L5 and L3-L4 interspaces and spine roentgenograms are the only special ancilary means in presurgical evaluation. We report three patients from our series, in which neoplasic spinal disease presented as classic LDP (one patient with a cauda equina schwannoma, and two with metastatic carcinoma). The cases were chosen because they posed special problems to the referred radiodiagnostic routine. Systematic CT-evaluation of the sacrum and conus medullaris zone is recommended in every patient with lumbosacral radiculopathy, and intratecal contrast should be employed in patients with unreliable findings or normal CT-scans.

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Departamento de Neurocirurgia, Hospital Vera Cruz - Av. Andrade Neves 402 - 13020 Campinas SP - Brasil

1. Dernbach PD, Weinstein MA, Little JR - Magnetic resonance imaging of spinal disorders. Clin Neurosurg 34:261, 1988.
2. Love JG - The differential diagnosis of intraspinal tumors and protruted intervertebral disks and their surgical treatment. J Neurosurg 1:275, 1944.
3. Meyer GA, Haughton VM, William AL - Diagnosis of herniated lumbar disk with computed tomography. N Engl J Med 301:1066, 1979.
4. Norlén G - On the value of the neurological symptoms in sciatica for the localization of a lumbar disc herniation: a contribution to the problem of the surgical treatment of sciatica. Acta Chir Scand 91 (Suppl) 95), 1944.
5. Roth-Vargas AA, Balbo RJ, Rossitti SL, Oliveira MA, Sperlescu A, Zuiani AR - Acometimento monorradicular neoplásico: diagnóstico diferencial com as discopatias lombares. Tema Oficial. XVII Congresso Brasileiro de Neurocirurgia, Brasília, 17-22 de setembro de 1988.
6. Schweller OG, Sperlescu A, Balbo RJ, Rossitti SL - Compressão mielorradicular por cisticercose. Rev Bras Reumatol 28:203, 1988.

Radiculopatia neoplásica lombossacral

Neoplasio lumbosacral radiculopathy

Datas de Publicação

Publicação nesta coleção
25 Maio 2011
Data do Fascículo
Mar 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Dernbach PD, Weinstein MA, Little JR - Magnetic resonance imaging of spinal disorders. Clin Neurosurg 34:261, 1988.

[2] 2. Love JG - The differential diagnosis of intraspinal tumors and protruted intervertebral disks and their surgical treatment. J Neurosurg 1:275, 1944.

[3] 3. Meyer GA, Haughton VM, William AL - Diagnosis of herniated lumbar disk with computed tomography. N Engl J Med 301:1066, 1979.

[4] 4. Norlén G - On the value of the neurological symptoms in sciatica for the localization of a lumbar disc herniation: a contribution to the problem of the surgical treatment of sciatica. Acta Chir Scand 91 (Suppl) 95), 1944.

[5] 5. Roth-Vargas AA, Balbo RJ, Rossitti SL, Oliveira MA, Sperlescu A, Zuiani AR - Acometimento monorradicular neoplásico: diagnóstico diferencial com as discopatias lombares. Tema Oficial. XVII Congresso Brasileiro de Neurocirurgia, Brasília, 17-22 de setembro de 1988.

[6] 6. Schweller OG, Sperlescu A, Balbo RJ, Rossitti SL - Compressão mielorradicular por cisticercose. Rev Bras Reumatol 28:203, 1988.