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Cochrane M, Hess M, Sajkowicz N. Posterior cord syndrome associated with postoperative seroma: The case to perform a complete neurologic exam. J Spinal Cord Med 2020; 43:892-894. [PMID: 30547736 PMCID: PMC7801031 DOI: 10.1080/10790268.2018.1550598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Context: Posterior cord syndrome (PCS) is the least common incomplete spinal cord injury. Findings of posterior cord syndrome include loss of proprioception and vibration, which are not routinely tested with the American Spinal Cord Injury Association's International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam and can easily be missed. Seromas may develop after spinal instrumentation and can cause cord compression. Findings: This case describes a unique presentation of posterior cord syndrome following a large seroma formation after laminectomy. A patient developed ataxia with functional decline following posterior laminectomy. Examination revealed loss of vibration and proprioception in the extremities with preservation of strength. Imaging of the cervical spine demonstrated a large fluid collection at the laminectomy site causing cord compression. The fluid collection was thought to represent a seroma based on clinical presentation, imaging, and laboratory testing. The patient was admitted to inpatient rehabilitation with improvement in function allowing discharge to home. Conclusion/clinical relevance: Seromas are a complication following cervical instrumentation that can cause compression of the adjacent spinal cord resulting in functional decline. The seroma, in this case, led to the loss of vibration and proprioception with resultant ataxia, signs that are not routinely identified on ISNCSCI exam; therefore, this highlights the need to broaden the neurological examination when evaluating a patient with spinal cord injury who has experienced a neurological setback.
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Affiliation(s)
- Meghan Cochrane
- Department of Spinal Cord Injury Medicine, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Marika Hess
- Department of Spinal Cord Injury Medicine, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Natalie Sajkowicz
- Physical Medicine and Rehabilitation Department, Tufts Medical Center, Boston, Massachusetts, USA
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Kitshoff AM, Van Goethem B, Cornelis I, Combes A, Dvm IP, Gielen I, Vandekerckhove P, de Rooster H. Minimally Invasive Drainage of a Post-Laminectomy Subfascial Seroma with Cervical Spinal Cord Compression. J Am Anim Hosp Assoc 2016; 52:175-80. [PMID: 27008321 DOI: 10.5326/jaaha-ms-6414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 14 mo old female neutered Doberman pinscher was evaluated for difficulty in rising, a wide based stance, pelvic limb gait abnormalities, and cervical pain of 2 mo duration. Neurologic examination revealed pelvic limb ataxia and cervical spinal hyperesthesia. Spinal reflexes and cranial nerve examination were normal. The pathology was localized to the C1-C5 or C6-T2 spinal cord segments. Computed tomography (CT) findings indicated bony proliferation of the caudal articular processes of C6 and the cranial articular processes of C7, resulting in bilateral dorsolateral spinal cord compression that was more pronounced on the left side. A limited dorsal laminectomy was performed at C6-C7. Due to progressive neurological deterioration, follow-up CT examination was performed 4 days postoperatively. At the level of the laminectomy defect, a subfacial seroma had developed, entering the spinal canal and causing significant spinal cord compression. Under ultrasonographic guidance a closed-suction wound catheter was placed. Drainage of the seroma successfully relieved its compressive effects on the spinal cord and the patient's neurological status improved. CT was a valuable tool in assessing spinal cord compression as a result of a postoperative subfascial seroma. Minimally invasive application of a wound catheter can be successfully used to manage this condition.
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Affiliation(s)
- Adriaan Mynhardt Kitshoff
- From the Department of Medicine and Clinical Biology of Small Animals (A.M.K., I.C., B.VG., I.P., H.dR.) and Department of Medical Imaging (A.C., I.G.), Ghent University, Merelbeke, Belgium; and the DAC Malpertuus, Heusden, Belgium (P.V.)
| | - Bart Van Goethem
- From the Department of Medicine and Clinical Biology of Small Animals (A.M.K., I.C., B.VG., I.P., H.dR.) and Department of Medical Imaging (A.C., I.G.), Ghent University, Merelbeke, Belgium; and the DAC Malpertuus, Heusden, Belgium (P.V.)
| | - Ine Cornelis
- From the Department of Medicine and Clinical Biology of Small Animals (A.M.K., I.C., B.VG., I.P., H.dR.) and Department of Medical Imaging (A.C., I.G.), Ghent University, Merelbeke, Belgium; and the DAC Malpertuus, Heusden, Belgium (P.V.)
| | - Anais Combes
- From the Department of Medicine and Clinical Biology of Small Animals (A.M.K., I.C., B.VG., I.P., H.dR.) and Department of Medical Imaging (A.C., I.G.), Ghent University, Merelbeke, Belgium; and the DAC Malpertuus, Heusden, Belgium (P.V.)
| | - Ingeborgh Polis Dvm
- From the Department of Medicine and Clinical Biology of Small Animals (A.M.K., I.C., B.VG., I.P., H.dR.) and Department of Medical Imaging (A.C., I.G.), Ghent University, Merelbeke, Belgium; and the DAC Malpertuus, Heusden, Belgium (P.V.)
| | - Ingrid Gielen
- From the Department of Medicine and Clinical Biology of Small Animals (A.M.K., I.C., B.VG., I.P., H.dR.) and Department of Medical Imaging (A.C., I.G.), Ghent University, Merelbeke, Belgium; and the DAC Malpertuus, Heusden, Belgium (P.V.)
| | - Peter Vandekerckhove
- From the Department of Medicine and Clinical Biology of Small Animals (A.M.K., I.C., B.VG., I.P., H.dR.) and Department of Medical Imaging (A.C., I.G.), Ghent University, Merelbeke, Belgium; and the DAC Malpertuus, Heusden, Belgium (P.V.)
| | - Hilde de Rooster
- From the Department of Medicine and Clinical Biology of Small Animals (A.M.K., I.C., B.VG., I.P., H.dR.) and Department of Medical Imaging (A.C., I.G.), Ghent University, Merelbeke, Belgium; and the DAC Malpertuus, Heusden, Belgium (P.V.)
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Taylor-Brown FE, Cardy TJA, Liebel FX, Garosi L, Kenny PJ, Volk HA, De Decker S. Risk factors for early post-operative neurological deterioration in dogs undergoing a cervical dorsal laminectomy or hemilaminectomy: 100 cases (2002-2014). Vet J 2015; 206:327-31. [PMID: 26542365 DOI: 10.1016/j.tvjl.2015.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 09/28/2015] [Accepted: 10/04/2015] [Indexed: 11/26/2022]
Abstract
Early post-operative neurological deterioration is a well-known complication following dorsal cervical laminectomies and hemilaminectomies in dogs. This study aimed to evaluate potential risk factors for early post-operative neurological deterioration following these surgical procedures. Medical records of 100 dogs that had undergone a cervical dorsal laminectomy or hemilaminectomy between 2002 and 2014 were assessed retrospectively. Assessed variables included signalment, bodyweight, duration of clinical signs, neurological status before surgery, diagnosis, surgical site, type and extent of surgery and duration of procedure. Outcome measures were neurological status immediately following surgery and duration of hospitalisation. Univariate statistical analysis was performed to identify variables to be included in a multivariate model. Diagnoses included osseous associated cervical spondylomyelopathy (OACSM; n = 41), acute intervertebral disk extrusion (IVDE; 31), meningioma (11), spinal arachnoid diverticulum (10) and vertebral arch anomalies (7). Overall 54% (95% CI 45.25-64.75) of dogs were neurologically worse 48 h post-operatively. Multivariate statistical analysis identified four factors significantly related to early post-operative neurological outcome. Diagnoses of OACSM or meningioma were considered the strongest variables to predict early post-operative neurological deterioration, followed by higher (more severely affected) neurological grade before surgery and longer surgery time. This information can aid in the management of expectations of clinical staff and owners with dogs undergoing these surgical procedures.
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Affiliation(s)
- F E Taylor-Brown
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK.
| | - T J A Cardy
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
| | - F X Liebel
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion SG5 3HR, UK
| | - L Garosi
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion SG5 3HR, UK
| | - P J Kenny
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
| | - H A Volk
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
| | - S De Decker
- Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
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Yew A, Kimball J, Lu DC. Surgical seroma formation following posterior cervical laminectomy and fusion without rhBMP-2. J Neurosurg Spine 2013; 19:297-300. [DOI: 10.3171/2013.5.spine121028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Seroma formation following posterior cervical laminectomy and fusion is now recognized as a rare but significant risk. Previous reports have attributed the development of postoperative seromas to the use of recombinant bone morphogenetic protein–2 (rhBMP-2). Here the authors present the case of a 78-year-old female with a history of osteoporosis who developed delayed postoperative neck and shoulder pain following posterior cervical laminectomy and fusion utilizing only autograft bone and demineralized bone matrix (DBM) allograft. Postoperative MRI demonstrated normal hardware placement and a large epidural fluid collection that extended from C-4 to C-6. The patient underwent decompression and drainage of her sterile postoperative seroma. To the authors' knowledge, no case of seroma formation with the use of DBM has been previously reported. This case suggests that although rhBMP-2 is involved in the majority of postoperative seroma developments, other osteoinductive agents such as DBM can contribute to the development of a symptomatic seroma. This report presents an illustrative case study and reviews the current understanding of the development of and treatment for cervical seroma following posterior cervical laminectomy and fusion.
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