Symptomatic pneumorachis associated with incidental durotomy during microscopic lumbar disc surgery

2006 ◽  
Vol 5 (2) ◽  
pp. 165-167 ◽  
Author(s):  
Aristedis Rovlias ◽  
Emmanuel Pavlakis ◽  
Serafim Kotsou
Keyword(s):  
Rare Complication ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Valve Mechanism ◽  
Reconstruction Process ◽  
Lumbar Microdiscectomy ◽  
First Case ◽  
Incidental Durotomy ◽  
Tomography Scan

✓ Unintended incidental durotomy is not a rare complication of lumbar microsurgery and is usually recognized and treated immediately. The reconstruction process can be complicated further by unpredictable factors. To their knowledge, the authors report the first case of a symptomatic pneumorachis associated with the accidental awakening of a patient during reconstruction of an incidental durotomy following lumbar microdiscectomy. Incomplete cauda equina syndrome developed in the patient on awakening from surgery after reconstruction of an unintended incidental dural tear that occurred during lumbar microdiscectomy. Symptomatic pneumorachis was revealed on an emergency computed tomography scan, and the patient underwent immediate repeated operation to remove air and decompress the spinal canal. The increasing number and complexity of surgical procedures in the lumbar spine contribute to the growing incidence of unintended durotomy. The surgeon should be aware of rare complications that may arise. Development of a vacuum phenomenon in conjunction with a ball–valve mechanism may lead to pneumorachis during durotomy repair. If this rare complication is promptly recognized and confronted, the outcome will not be associated with long-term sequelae.

Cauda Equina Syndrome Due To Dural Sac Shift with Engorgement of the Epidural Venous Plexus: Rare Complication After Lumbar Microdiscectomy

2017 ◽  
Vol 104 ◽  
pp. 1048.e15-1048.e18 ◽  
Author(s):  
Yoshinori Maki ◽  
Motohiro Takayama ◽  
Hideki Hayashi ◽  
Yohei Yokoyama ◽  
Yuji Agawa
Keyword(s):  
Cauda Equina Syndrome ◽  
Rare Complication ◽  
Cauda Equina ◽  
Venous Plexus ◽  
Lumbar Microdiscectomy ◽  
Dural Sac

Lumbar Arthroplasty Core Herniation Presenting With Cauda Equina Syndrome: Case Report of a Rare Complication

2018 ◽  
Vol 16 (5) ◽  
pp. 614-618
Author(s):  
Clay M Elswick ◽  
Hazem M Ahmed
Keyword(s):  
Cauda Equina Syndrome ◽  
Rare Complication ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Preoperative Imaging ◽  
Unusual Complication ◽  
Artificial Disc ◽  
Radiographic Findings ◽  
Multiple Imaging ◽  
Work Up

Abstract BACKGROUND Treatment failures of artificial disc implantation are well-described, but posterior herniation of the arthroplasty core is rare. We present a case of posterior herniation of the arthroplasty core resulting in cauda equina syndrome in a 36-yr-old woman. Preoperative imaging studies including computed tomography (CT), magnetic resonance imaging (MRI), and CT Myelogram were performed; only the CT Myelogram demonstrated the severe compression well. This report highlights the radiographic findings on multiple imaging modalities, clinical implications, and management considerations of posterior arthroplasty failures. OBJECTIVE To demonstrate a rare complication of lumbar arthroplasties. The biomechanical considerations, surgical management, and thorough radiographic work-up demonstrate successful diagnosis and treatment of this unusual complication. METHODS The patient's chart was reviewed for medical history, laboratory and radiographic studies, and outpatient clinical follow-up. RESULTS After imaging work-up, this patient was found to have a herniation of the arthroplasty core at L5-S1. She was taken emergently to the operating room for a decompression at L5-S1 and arthroplasty core removal. She made some recovery neurological, but over 3 mo time, she developed a spondylolisthesis with new back pain and radiculopathy. This ultimately responded well to an L5-S1 instrumented posterior fusion. CONCLUSION Posterior herniation of the lumbar arthroplasty core is a rare complication from implantation of an artificial lumbar disc. Confirmation of the diagnosis is best confirmed with a CT Myelogram. Furthermore, this case underscores the biomechanical importance of the artificial disc given the development of the spondylolisthesis after removal, and fusion after arthroplasty core removal should be considered.

Postoperative cauda equina syndrome in patients undergoing single-level lumbar microdiscectomy

2005 ◽  
Vol 19 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Vassilios Dimopoulos ◽  
Kostas N. Fountas ◽  
Theofilos G. Machinis ◽  
Carlos Feltes ◽  
Induk Chung ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
De Novo ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Clinical Findings ◽  
Magnetic Resonance Images ◽  
Single Level ◽  
Lumbar Microdiscectomy ◽  
First Case ◽  
Intraoperative Electrophysiological Monitoring

Cauda equina syndrome is a well-documented complication of uneventful lumbar microdiscectomy. In the vast majority of cases, no radiological explanation can be obtained. In this paper, the authors report two cases of postoperative cauda equina syndrome in patients undergoing single-level de novo lumbar microdiscectomy in which intraoperative electrophysiological monitoring was used. In both patients, the amplitudes of cortical and subcortical intraoperative somatosensory evoked potentials (SSEPs) abruptly decreased during discectomy and foraminotomy. In the first patient, a slow, partial improvement of SSEPs was observed before the end of the operation, whereas no improvement was observed in the second patient. In the first case, clinical findings consistent with cauda equina syndrome were seen immediately postoperatively, whereas in the second one the symptoms developed within 1.5 hours after the procedure. Postoperative magnetic resonance images obtained in both patients, and a lumbar myelogram obtained in the second one revealed no signs of conus medullaris or nerve root compression. Both patients showed marked improvement after an intense course of rehabilitation. The authors' findings support the proposition that intraoperative SSEP monitoring may be useful in predicting the development of cauda equina syndrome in patients undergoing lumbar microdiscectomy. Nevertheless, further prospective clinical studies are necessary for validation of these findings.

The Long-term Clinical Sequelae of Incidental Durotomy in Lumbar Disc Surgery

Spine ◽  
2005 ◽  
Vol 30 (20) ◽  
pp. 2298-2302 ◽  
Author(s):  
Guido Saxler ◽  
J??rgen Kr??mer ◽  
Bertram Barden ◽  
Asik Kurt ◽  
J??rg Pf??rtner ◽  
...  
Keyword(s):  
Lumbar Disc ◽  
Lumbar Disc Surgery ◽  
Disc Surgery ◽  
Incidental Durotomy

scholarly journals Spinal subdural hygroma as a post-operative complication in revision spine fusion: a case report

2019 ◽  
Vol 2019 (11) ◽  
Author(s):  
Michelle J Nentwig ◽  
Camden M Whitaker ◽  
Shang-You Yang
Keyword(s):  
Lumbar Spine ◽  
Cauda Equina Syndrome ◽  
Rare Complication ◽  
Fluid Collection ◽  
Cauda Equina ◽  
Spine Fusion ◽  
Lumbar Spine Surgery ◽  
Subdural Hygroma ◽  
Lumbar Spine Fusion ◽  
First Case

Abstract Lumbar spine fusion has become a common and effective procedure in orthopedic practice, and a spinal subdural hygroma development is a rare complication following this procedure. We report here the case of a revision lumbar spine fusion at levels L4-5, L5-S1, where the patient subsequently developed cauda equina syndrome 2 days post-operatively. Magnetic resonance imaging (MRI) showed a subdural, extra-arachnoid fluid collection from T12-L2, cephalad to the site of spine fusion. It appears the first case reported a subdural hygroma developed cephalad to the site of spine fusion. When a patient complains of radicular pain along with urinary retention and neurologic deficits post-lumbar spine surgery, cauda equina syndrome possibly caused by subdural hygroma should be considered. This warrants immediate MRI and emergent reoperation to relieve the pressure on the spinal cord may be necessary.

Diffuse alveolar hemorrhage associated with ustekinumab treatment

2021 ◽  
Author(s):  
Kulothungan Gunasekaran ◽  
Anant Shukla ◽  
Nageshwari Palanisamy ◽  
Mandeep Singh Rahi ◽  
Armand Wolff
Keyword(s):  
Temporal Relationship ◽  
Case Reports ◽  
Rare Complication ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Drug Discontinuation ◽  
Computed Tomography Scan ◽  
First Case ◽  
Lupus Syndrome ◽  
Tomography Scan

Abstract Purpose A case of diffuse alveolar hemorrhage (DAH) occurring as a reaction to ustekinumab therapy is reported. Summary After starting ustekinumab for treatment of psoriatric arthritis, a 46-year-old female presented with flu-like symptoms and cough with blood-tinged sputum that had begun 1 week previously. Her initial computed tomography scan of the chest demonstrated bilateral ground-glass opacities. On bronchoscopy, the bronchoalveolar lavage (BAL) return became bloodier from sample 1 to samples 2 and 3. Her BAL fluid was more than 90% hemosiderin-laden macrophages, a finding consistent with DAH. We ruled out infectious etiologies and other common vasculitis conditions that can cause DAH. A diagnosis of ustekinumab-induced DAH was made due to a temporal relationship between initiation of the drug and the patient’s presentation and the absence of infection and other alternate diagnosis. Prior case reports including ustekinumab-induced pneumonitis, interstitial lung disease with a granulomatous component, and lupus syndrome have been reported, with this being the first case of DAH in a patient undergoing treatment of psoriatic arthritis. Conclusion A 46-year-old woman developed DAH during ustekinumab treatment. Symptoms abated after drug discontinuation and supportive treament. Clinicians must remain mindful of this rare complication of ustekinumab use in order to avoid potential delays in appropriate DAH treatment.

scholarly journals Non-compressive postoperative cauda equina syndrome following decompression and transforaminal interbody fusion surgery

2018 ◽  
Vol 11 (1) ◽  
pp. e227219
Author(s):  
Mantu Jain ◽  
Sudhanshu Sekhar Das ◽  
Sudarsan Behera ◽  
Amit Tirpude
Keyword(s):  
Conservative Management ◽  
Cauda Equina Syndrome ◽  
Interbody Fusion ◽  
Rare Complication ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Favourable Outcome ◽  
Surgical Exploration ◽  
Postoperative Imaging ◽  
Transforaminal Interbody Fusion

Postoperative cauda equina syndrome (CES) is a known rare complication following lumbar disc surgery. Seldom are they seen following decompression for spinal stenosis and may be actually more frequent and under-reported? Emergent surgical exploration remains the mainstay of management as the factors responsible for postop CES remains a variety of compressive forces. Yet many a time postoperative imaging or surgical exploration fails to identify a pathology and this leads to an ischaemic theory responsible for CES. Our article highlights conservative management in these selective group. We share our experience in two cases of incomplete CES during our routine transforaminal interbody fusion which we followed closely without re-exploration eventually ending in a favourable outcome. Key messages: The factors responsible for postop CES remains mostly a variety of compressive forces though in some instances postoperative imaging or surgical exploration fails to identify such in some cases. This leads to an ischaemic theory responsible for CES. The role of conservative management of postoperative CES in certain selective cases has a favourable outcome as illustrated in our cases.

scholarly journals A Case Series of Acute Painless Bilateral Foot Drop Without Cauda Equina Syndrome

2021 ◽  
Vol 11 (10) ◽  
Author(s):  
Manoj Kumar ◽  
Nikhil Jain ◽  
Nitin Adsul ◽  
Shankar Acharya ◽  
R. S. Chahal ◽  
...  
Keyword(s):  
Early Intervention ◽  
Case Reports ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Case Series ◽  
Foot Drop ◽  
Neurological Recovery ◽  
Rare Presentation ◽  
Duration Of Symptoms ◽  
First Case

Introduction:Acute painless bilateral foot drop without bowel/bladder involvement is a very rare presentation of lumbar degenerative disorders. Only a few cases have been published on it in the literature. An early intervention could prove to be very helpful for the neurological recovery. Case Report:We present three cases where patients developed acute onset bilateral foot drop without radiculopathy and without bowel/bladder involvement. The first case was due to acute lumbar disc herniation, the second was caused by acute disc prolapse in a pre-existing asymptomatic lumbar canal stenosis, and the third one precipitated in a progressive degenerative severe lumbar spinal stenosis. Two cases (case reports 1 and 3) underwent minimal invasive decompression while the other case (case report 2) underwent instrumentation+ decompression + fusion. Case 1 and 2 with a short duration of symptoms showed good neurological recovery, whileereas cCase 3 with longer duration of complaints did not improve. Conclusion:Patients presenting with painless bilateral foot drop without cauda equine syndrome should be evaluated for spinal causes besides central nervous systemCNS, peripheral nerve, metabolic and autoimmune causes. Any finding in support of lumbar degenerative disease as the cause after excluding other causes should prompt for surgical decompression of the spine as an early intervention might help patient recover back to a normal and active lifestyle. Keywords:Painless, bilateral, foot drop, acute.

scholarly journals Transforaminal Endoscopic Lumbar Discectomy Versus Open Lumbar Microdiscectomy: A Comparative Cohort Study with a 5-Year Follow-Up

2019 ◽  
Vol 3 (22;3) ◽  
pp. 295-304
Author(s):  
Yong Ahn
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Operative Time ◽  
Lumbar Disc ◽  
Open Group ◽  
Lumbar Microdiscectomy ◽  
Endoscopic Discectomy ◽  
Endoscopic Lumbar Discectomy

Background: Transforaminal endoscopic lumbar discectomy (TELD) is regarded as an effective treatment option for soft lumbar disc herniation (LDH). There have been few studies evaluating the long-term outcomes of endoscopic procedures compared with conventional surgery. Objectives: The objective of this study was to demonstrate the clinical outcomes of TELD compared with those of open lumbar microdiscectomy. Study Design: Between January 2009 and September 2011, 335 consecutive patients with symptomatic LDH were treated with decompressive discectomy, either TELD or open microdiscectomy. Patients were prospectively entered into the clinical database and their records were retrospectively reviewed. Setting: Hospital and outpatient surgical center. Methods: Data from 298 patients who were treated with decompressive discectomy, either TELD or open microdiscectomy, were evaluated with a minimum 5-year follow-up period. Among them, 146 patients were treated using TELD (TELD group), and the remaining 152 patients using open microdiscectomy (Open group). Perioperative data and clinical outcomes were evaluated using the visual analog scale (VAS), the Oswestry Disability Index (ODI), and the modified Macnab criteria. Results: The VAS and ODI significantly improved in both groups. The rate of excellent or good outcomes was 88.36% and 87.5% in the TELD and Open group, respectively. The reoperation rate was 4.2% and 3.3% in the TELD and Open group, respectively. There were no significant differences in the clinical outcomes; however, operative time, hospital stay, and time to return to work were significantly shorter in the TELD group (P < 0.01). Limitations: First, the patient selection was not randomized; therefore, the risk of bias might be increased. Second, this study lacks analysis of the radiographic changes related to the degenerative change over the long-term follow-up period. Conclusions: The long-term results of TELD for soft LDH are comparable to those of conventional open microdiscectomy. The selective endoscopic discectomy technique under local anesthesia provides the typical advantages of minimally invasive procedures such as a shorter operation time, hospital stay, and recovery time. Key words: Endoscopic, discectomy, hospital stay, lumbar disc, microscopic, operative time, return to work, transforaminal

scholarly journals All that glitters is not gold: A spinal epidural empyema following epidural steroid injection

2020 ◽  
Vol 11 ◽  
pp. 240
Author(s):  
Lara Brunasso ◽  
Luigi Basile ◽  
Domenico Gerardo Iacopino ◽  
Carlo Gulì ◽  
Francesca Graziano ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Leg Pain ◽  
Neurological Sequelae ◽  
Nonsurgical Management ◽  
Lumbar Spinal ◽  
Epidural Steroid ◽  
Spinal Epidural

Background: Therapeutic epidural spinal injections (ESIs) of steroids are one of the most common nonsurgical management modalities employed for alleviating pain due to chronic persistent lumbar spinal disease. However, it is well documented that they have significant risks and complications without any long-term efficacy. ESI may result in epidural empyema which may be difficult to diagnose with delays resulting in significant permanent neurological sequelae. Case Description: A 45-year-old female presented with a lumbar spinal epidural empyema after receiving ESI for low back and right leg pain due to a lumbar disc herniation. Laboratory studies showed elevations of multiple inflammatory markers, and the MR documented a significant lumbar epidural empyema contributing to significant thecal sac compression. Clinically, the patient had an acute cauda equina syndrome warranting emergency surgery consisting of a laminectomy for debridement/decompression followed by long-term antibiotic treatment. Conclusion: Epidural empyema is a major potential complication of lumbar ESI. Multiple markedly elevated inflammatory markers (WBC, ESR, CRP, and procalcitonin) and MRI evidence of an epidural empyema necessitates emergent surgical intervention to limit morbidity, neurological sequelae, and mortality.

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