The Chiropractic Doctors' Association of Hong Kong

研究中一名30歲的男性，有4年的慢性背痛病史，他抱怨最近在一周前打籃球時扭傷，背痛發現劇烈的疼痛一直扯到下背部和臀部的地方。到醫院的時候，磁共振成像顯示有明顯的椎間盤突出水壓迫T12 / L1脊髓。在經過兩星期的脊醫治療後，他的搖肺部活動能力明顯增加。很意外的，患者長年的晚上尿床習慣也突然消失。

遺尿症又叫尿床，是指在不適當的時間或是不適當的地點，產生的正常排尿情況。遺尿症有別於一般的尿失禁，因為遺尿症是一個完整的排尿過程，只不過在這個排尿過程當中，病人並未意識到他有排尿的感覺。椎間盤突出症是遺尿症的一個經常被忽視的原因。研究發現胸腰椎間盤突出症是引起的脊髓壓迫的罕見結果。

在沒有嚴重的脊髓病的情況下，醫生團隊主張用非手術治療和定期監測治療椎間盤突出的症狀。手術治療通常是在保守治療的過程中得不到療效，才會使用侵入性的方法且走椎間盤的壓迫。脊骨神經治療主要是包括脊椎矯正、肌肉刺激、或者是機械人脊椎牽引。經過二個星期的脊醫治療後，神經痛得到了舒緩，椎間盤突出也縮回和消退。

REFERENCES

1. Von Gontard A, Cardozo L, Rantell A, Djurhuus JC. Adolescents with nocturnal enuresis and daytime urinary incontinence— How can pediatric and adult care be improved—ICI-RS 2015. Neurourol Urodynam 2017;36:843–849.

2. Adam A, Claassen F, Coovadia A, et al. The South African guidelines on enuresis2017. Afr J Urol 2018;24(1):1-13.

3. Selvaraj PR, Thirumalai R. Late adolescent primary nocturnal enuresis: a case report. Int J Res Med Sci 2017;5(11):5075-5078.

4. Brauge D, Madkouri R, Clement R, et al. What are the possibilities of spontaneous resorption of a thoracic disc herniation occupying more than 20% ofthe spinal canal in the asymptomatic subject? Comparative study. J Clin Neurosci 2017; 44:269-273.

5. Shah A, Botchu R, Grainger MF, et al. Acute symptomatic calcific discitis in adults: a case report and review of literature. Skeletal Radiol 2015;44(12):1819– 1824.

6. Inoue T. Pure conus medullaris syndrome without lower extremity involvement caused by intradural disc herniation at L1/2: a case report. Spine Surg Relat Res 2019;3:392–395.

7. Nene Y, Jilani TN. Neuroanatomy, conus medullaris. In: StatPearls, Internet. Treasure Island, FL: StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545227/.

8. Brouwers E, van de Meent H, Curt A, et al. Definitions of traumatic conus medullaris and cauda equina syndrome: a systematic literature review. Spinal Cord 2017;55:886–890.

9. Rider IS, Marra EM. Cauda equina and conus medullaris syndromes. In: StatPearls, Internet. Treasure Island, FL: StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537200/.

10. Yeung CK, Sit FK, To LK, et al. Reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis. BJU Int 2002;90(3):302–307.

11. Siracusa G, Sparacino A, Lentini VL. Neurogenic bladder and disc disease: a brief review. Curr Med Res Opin 2013;29(8):1025–1031.

12. Reed WR, Beavers S, Reddy SK, Kern G. Chiropractic management of primary nocturnal enuresis. J Manipulative Physiol Ther 1994;17:596–600.

13. van Poecke AJ, Cunliffe C. Chiropractic treatment for primary nocturnal enuresis: a case series 33 consecutive patients. J Manipulative Physiol Ther 2009; 32:675– 81.

14. Instebø E, Lystad RP. Chiropractic care of an 8-year-old girl with nonorganic, primary nocturnal enuresis: a case report. J Chiropr Med 2016;15:47–52.

15. Chu ECP, Chakkaravarthy DM, Lo FS, Bhaumik A. Regression of lumbar disc herniation following nonsurgical treatment. Eur J Mol Clin Med 2020;7(1): 27– 29.