Læknablaðið - 01.03.1979, Blaðsíða 67

LÆKNABLAÐIÐ
39
ganglimum og engin óhljóð yfir æðum. Myelo-
grafia leiðir nú í ljós brjósklos milli L IV og L
V v.megin og mænugangurinn er þröngur eða
12 mm á bilinu L II—L IV.
Við aðgerð finnst nefnt brjósklos og er það
fjarlægt. Jafnframt (er gerð laminectomia
beggja vegna á svæðinu L II—L IV þar sem
þrengsli eru mest. Laminur eru mjög þykkar
og liðbönd einnig, epidural fita er horfin og
stoðvefurinn þrýstir að rótum mænutagls, sem
fyrst fara að slá eðlilega eftir að laminur hafa
verið fjarlægðar. Eftir aðgerð hafa verkir
horfið og „intermittent claudication" einnig.
Máttur hefur alveg komið í h.ganglim og fer
batnandi í þeim v., en skyntruflanir sem komn-
ar voru fyrir aðgerð, eru svipaðar.
ENGLISH SUMMARY
This paper describes 6 patients with inter-
mittent claudication of neurogenic origin. AU
the patients had intermittent claudication of
the cauda equina due primarily to a narrow
spinal canal. The mechanism for the pro-
duction of symptoms as suggested by other
authors is explained and accordingly 3 of
the patients are placed into the primarily
postural group and the other 3 into the
primarily ischemic group. The symptoms
of all these patients are described and the
peculiarities which might give a clue to a
correct clinical diagnosis are emphasized. These
include the disparity between complaints and
clinical findings and the presence of clinical
signs following exercise or hyperextension of
the spine only in the postural group of patients.
In all CEises sensory symptoms preceded motor
manifestations and the typical „sensory march“
was observed in all cases. In one patient loss
of sphincters' control followed the ssnsory
symptoms. The diagnostic value of measuring
the diameter of the spinal canal on plain radio-
grams and on míyelograms is discussed. One
patient had spinal block. The AP-diameter of
the other spinal canals ranged from 8—15 mm.
Lauminectomy relieved the intermittent pain
and the „sensory march" and prevented further
weakness and sensory loss already present in
long-standing cases. The former was improved
but the latter remained much unchanged.
Sphincters' control was restored to normal.
None of our patients had any evidence of
intermittent claudication primarily due to
ischemic muscles. The differences in clinical
and investigatory Æindings in intermittent
claudication of primarily vascular vs neuro-
genic origin are enlisted. It is emphasized that
a narrow canal should be looked for in patients
who do not improve as expected following con-
ventional surgical treatment of prolapsed inter-
vertebral discs and whose intermittent claudi-
cations has no vascuiar explanation.
HEIMILDIR
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