Síndrome compartimental bilateral en miembros inferiores tras cirugía de schwannoma lumbar en posición genupectoral

A multicentre retrospective review of muscle necrosis of the leg following spinal surgery with motor evoked potential monitoring: a cause for concern?

PURPOSE

There are very few reported cases of compartment syndrome of the leg following spinal surgery via a posterior approach. An association between compartment syndrome and muscle over-activity via nerve stimulation during evoked potential monitoring was first suggested in 2003. No further reports have suggested this link. We present a multicentre retrospective review of a series of five patients who developed compartment syndrome of the leg following spinal surgery via a posterior approach, whilst un-paralysed and with combined sensory (SSEP)/motor evoked potential (MEP) monitoring with an aim of highlighting this possible causative factor.

METHODS

All data were collected contemporaneously and retrospective analysis was performed. We then arranged for a multidisciplinary review of the cases including surgeons, anaesthetists, radiologists, neurophysiologists and theatre and ward nursing staff. Finally, the literature was reviewed.

RESULTS

All patients were operated on by three different surgeons, on different operating tables/mattresses in the prone position. The common factors were un-paralysed patients having motor/sensory monitoring, mechanical calf pumps and total intravenous anaesthesia. Three patients underwent surgical decompression of their compartments and two were treated expectantly. Three patients had confirmed intra-compartmental changes on MRI consistent with compartment syndrome and one had intra-compartmental pressure monitoring which confirmed the diagnosis.

CONCLUSIONS

Previous cases in the literature have related to mal-positioning on the Jackson table or use of the knee-chest position for surgery. This was not the case for our patients; therefore, we suspect an association between overactive muscle stimulation and muscle necrosis. Further experimental studies investigating this link are required.

Anterior thigh compartment syndrome and local myonecrosis after posterior spine surgery on a Jackson table

BACKGROUND

Acute compartment syndrome (ACS) after posterior spinal surgery is very uncommon. Most of the reported cases have ACS in the legs related to positioning in the knee-chest position; postoperative ACS in the thighs is exceedingly rare, with only one reported case (17).

CASE DESCRIPTION

This study reports two patients who had local muscle necrosis/ACS after spine surgery in the prone position and discusses preventive measures. Both of our complications were probably related to reversing the position of the iliac crest and hip pads on a Jackson operating table, which was done to achieve better lumbar lordosis.

CONCLUSIONS

Our cases indicate the need for a high index of suspicion of ACS in patients who have persistent unresolved pain and local swelling. Tissue pressure monitoring is an option in suspected cases. Iliac crest and thigh pads should not be reversed during positioning on a Jackson table.

Lithotomy-related neurovascular complications in the lower limbs after colorectal surgery

AIM

To review the literature on lithotomy-related neurovascular complications (LRNVC) of the lower limbs after colorectal surgery.

METHOD

Electronic databases were searched for relevant articles, including Medline, EMBASE, Pubmed, CENTRAL and CINHL.

RESULTS

LRNVC after prolonged lithotomy position during colorectal surgery can be classified into vascular, neurological and neurovascular combined. Compartment syndrome (CS) is the most common clinical presentation. Seven case reports and 10 case series on 34 patients (27 men, 6 women) with CS have been reported. Risk factors included the lithotomy position and duration of surgery of more than 4 h.

CONCLUSION

In colorectal surgery, lower limb LRNCVs, and CS are rare. A high index of clinical suspicion and early decompression may reduce morbidity.

Rhabdomyolysis after transnasal repair of anterior basal encephalocele

BACKGROUND

Postoperative Rhabdomyolysis (RM) is rare after neurosurgical procedures. Furthermore, it has not been observed after transnasal approaches. The authors report a case of idiopathic RM occurring after transnasal resection of a sincipital encephalocele.

CASE DESCRIPTION

A 32-year-old woman underwent a transnasal resection of a sincipital encephalocele after 6 years of intermittent clear nasal drainage. Postoperatively, she experienced severe back pain, peripheral neuropathy, associated with a markedly elevated creatinine kinase, and severe RM. The patient was treated with hydration and forced urine alkalization and treated symptomatically for her pain and neuropathy. She ultimately made a full recovery without complication.

CONCLUSION

Rhabdomyolysis is a rare but known complication of neurosurgical procedures. We report the first known case report of RM after a transnasal procedure. Furthermore, a review of documented postneurosurgical cases of RM is presented and reveals that the causes and risk factors for this complication after neurosurgery are similar to those in other surgical subspecialties.