抄録
Three cases with lumbar spinal lesions caused by severe lumbar compression fractures in rheumatoid arthritis (RA) are reported on.
They were 61, 60 and 69 year-old females with classical RA, all with severe low backache with paraplegia caused by compression of the cauda equina. They also had vesico-rectal disfunction and were unable to walk. Such cauda compression was clearly indicated by myelography and computer tomography of the responsible focus corresponding to the neurological findings.
Two cases were conservatively treated with bed rest and pelvic traction for about two months, following application of a corset. Paraplegia disappeared but mild low backache remained in one case and the other was still unable to walk due to knee pain after joint replacement. In the one case operated on, laminectomy with posterolateral fusion was done after conservative treatment for four months, as clinical symptoms advanced, including complications of vesicorectal disfunction. Paraplegia was almost cured with respect to muscle and sensory recovery, but neurogenic bladder still remained.
The pathomechanism of the lumbar spinal lesion in RA seemed to be that the instability of the spine due to vertebral body fracture and facet erosion probably with rheumatoid inflamation, advancing to the dislocation of the spine. Basically, severe osteoporosis in the disease course, aging and steroid administration can be related to the causes of the lesion.
In advanced RA cases with palsy, care of the spinal column lesion is very difficult with respect to acheiving a complete cure, but is necessary for maintaining the patient's life.
