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Chen Z, Lin C. Tarlov cyst with self-healing cauda equina syndrome following combined spinal-epidural anesthesia: a case report. BMC Anesthesiol 2023; 23:352. [PMID: 37907852 PMCID: PMC10617098 DOI: 10.1186/s12871-023-02311-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Cauda Equina Syndrome (CES) after Combined Spinal-Epidural Anesthesia (CSEA) is a rare disease that most of the time need surgery to relieve spinal cord compression. CASE PRESENTATION A 34-year-old male patient underwent a procedure for prolapse and hemorrhoids (PPH) under CSEA. Anesthesia and surgery were uneventful. However, the patient gradually experienced urinary retention, lower abdomen and back pain, changes in bowel habits and neurological dysfunction of the lower limbs when the catheter was removed. It was later determined that the patient had Tarlov cyst at the left S1 level in the sacral canal. Finally, the patient completely recovered 20 days after drug conservative therapy onset. CONCLUSION This case suggests that CES might occur even after ordinary CSEA. The risk factors are drug neurotoxicity to ropivacaine and Tarlov cyst, which helped to accumulate ropivacaine. The development of ultrasound-guided CSEA and an ultrasound atlas of the spinal canal are required.
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Affiliation(s)
- Zhexuan Chen
- Jieyang People's Hospital, Jieyang, Guangdong Province, China
| | - Chuxi Lin
- Jieyang People's Hospital, Jieyang, Guangdong Province, China.
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Ma R, Zheng Z, Zhou X, Zhu W, Chen J, Zhang R, Liu Z, Xu Y, Fu M, Liu Z, Zhao Q, Li Q. An anatomical study of the origins courses and distributions of the transverse branches of lumbar arteries at the L1-L4 levels. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:678-684. [PMID: 35094163 DOI: 10.1007/s00586-022-07124-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/05/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
Pseudoaneurysms of the lumbar arteries following transforaminal lumbar interbody fusion (TLIF) are rare postoperative complications that usually occur around the transverse process. However, there are few detailed descriptions of the transverse branch and other branches of the dorsal branches at the L1-L4 disks. STUDY DESIGN Ten adult embalmed cadavers were anatomically studied. OBJECTIVES The purposes of the study were to describe the vascular distribution of the dorsal branches, especially the transverse branches, at the L1-L4 levels and provide information useful for TLIF. METHODS Ten embalmed cadavers studied after their arterial systems were injected with red latex. The quantity, origin, pathway, distribution range and diameter of the branches were recorded and photographed. RESULTS The transverse branch appeared in all 80 intervertebral foramina. The transverse branch was divided into 2 types: In type 1, the arteries divided into superior branches and inferior branches; the arteries in type 2 divided into 3 branches (superior, intermedius and inferior branches). CONCLUSIONS The transverse branches of the dorsal arteries are common structures from L1 to L4, and 2 types of transverse branches were found. A thorough understanding of the dorsal branches, especially the transverse branches of the lumbar artery, may be very important for reducing both intraoperative bleeding during the surgery and the occurrence of pseudoaneurysms after transforaminal lumbar interbody fusion.
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Affiliation(s)
- Runxun Ma
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Zhiyang Zheng
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Xinying Zhou
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Weijia Zhu
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Junjie Chen
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Rusen Zhang
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Zexian Liu
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Yejie Xu
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Maoqing Fu
- Department of Spine Surgery, Nanhai Hospital, Southern Medical University, Nanhai District, 528244, Foshan, Guangdong, People's Republic of China
| | - Zezheng Liu
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Qinghao Zhao
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China.
| | - Qingchu Li
- Guangdong Province, Department of Orthopedics, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China.
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Bellido-Yarlequé D, Rosadio-Portilla L, Tan-Kuong J, Bautista-Sánchez F, Zúñiga-Luna C, Cuya-Ochoa W. Massive Pulmonary Embolism due to Inferior Vena Cava Thrombosis Related to Compression by Lumbar Artery Pseudoaneurysm. A Case Report and Review of Literature. Ann Vasc Surg 2021; 74:520.e1-520.e9. [PMID: 33556505 DOI: 10.1016/j.avsg.2021.01.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Lumbar artery pseudoaneurysm (LAPA) is a pathology infrequently described in the literature. The most frequent complications are the expansion and rupture of the pseudoaneurysm. Reports of association between PE with LAPA have not yet been described. We present a 53-year-old male patient with LAPA whose expansion caused compression of the inferior vena cava and subsequently PE. He underwent mechanical thrombectomy and inferior cava vein filter placement associated with embolization of the LAPA. Despite the severe clinical profile, the patient was discharged with a favorable postoperative course without complications. This case report also includes a review of the literature.
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Affiliation(s)
- David Bellido-Yarlequé
- Department of Vascular Surgery, Guillermo Almenara Irigoyen National Hospital, Lima, Peru.
| | - Luz Rosadio-Portilla
- Department of Vascular Surgery, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
| | - Jesús Tan-Kuong
- Department of Interventional Radiology, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
| | | | - Carlos Zúñiga-Luna
- Department of Vascular Surgery, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
| | - Wernher Cuya-Ochoa
- Department of Vascular Surgery, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
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