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Halayqeh S, Glueck J, Balmaceno-Criss M, Alsoof D, McDonald CL, Diebo BG, Daniels AH. Delayed cerebrospinal fluid (CSF) leak following anterior cervical discectomy and fusion surgery. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100271. [PMID: 37771759 PMCID: PMC10522904 DOI: 10.1016/j.xnsj.2023.100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/30/2023]
Abstract
Background An uncommon complication of anterior cervical discectomy and fusion (ACDF) is dura tear, which may be further complicated by cerebral spinal fluid (CSF) leak. Dural tears with CSF leak can lead to catastrophic neurologic outcomes and should be recognized early. Case Description This case report describes a 43-year-old female patient with history of Ehlers-Danlos syndrome who presented 1-year post-ACDF with positional headaches and lightheadedness. Imaging revealed ACDF plate subsidence and CSF leak with inferior displacement of the cerebellar tonsils. Outcome The patient underwent a revision procedure with removal of index screws and CSF repair using epidural blood patch, fat graft, and Tisseel. The original bicortical screws were replaced with shorter larger diameter unicortical screws. Post-operative imaging at 2 and 6 weeks confirmed resolution of CSF leak. Conclusions Healthcare professionals and patients undergoing spinal surgery should be aware of late presentation CSF leaks which can represent gradual decline in neurological function. Surgical candidates at risk to develop CSF leaks should be counseled about possible complications in preoperative planning.
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Affiliation(s)
- Sereen Halayqeh
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
| | - Jacob Glueck
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
- Warren Alpert Medical School, Brown University, 222 Richmond St., RI, 02903 United States
| | - Mariah Balmaceno-Criss
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
- Warren Alpert Medical School, Brown University, 222 Richmond St., RI, 02903 United States
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
- Warren Alpert Medical School, Brown University, 222 Richmond St., RI, 02903 United States
| | - Christopher L. McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
| | - Bassel G. Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
| | - Alan H. Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 1 Kettle Point Ave East Providence, RI, 02914 United States
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Tzerefos C, Paterakis K, Bouramas D, Fotakopoulos G, Brotis A, Fountas K. Late-Onset Cervical Pseudomeningocele Following Ossification of the Posterior Longitudinal Ligament Surgery Successfully Treated With a Lumboperitoneal Shunt. Cureus 2022; 14:e30744. [DOI: 10.7759/cureus.30744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/07/2022] Open
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McMahon PW, Loewenstern J, Girgis P, Tsiouris AJ, Fink M, Härtl R, Salama G. Progressive superficial siderosis from Chronic CSF leak as a long-term complication of cervical anterior corpectomy: A case report and review of the literature. Surg Neurol Int 2022; 13:341. [PMID: 36128162 PMCID: PMC9479579 DOI: 10.25259/sni_493_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Superficial siderosis of the central nervous system (SSCNS) is a rare progressive neurological disorder resulting from chronic subarachnoid hemorrhage and subsequent subpial hemosiderin deposition. A prolonged cerebrospinal fluid (CSF) leak is a known cause of SSCNS. We present a novel case where progressive SSCNS resulted from a chronic CSF leak related to an anterior cervical corpectomy. Case Description: A 73-year-old man presented with gait ataxia and progressive hearing loss. Thirteen years before, he had undergone a combined anterior-posterior cervical decompression for symptomatic ossification of the posterior longitudinal ligament (OPLL). The presenting MR imaging showed extensive superficial siderosis and focal spinal cord herniation at the site of a ventral dural defect at the corpectomy site. A CT myelogram showed extensive CSF leakage into the corpectomy surgical site and a communicating pseudomeningocele in the anterior neck. Conclusion: This is the first reported case of progressive SSCNS as a long-term complication of an anterior cervical corpectomy for OPLL. Clinicians should be aware of SSCNS secondary to a chronic CSF leak in patients with a prior corpectomy.
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Affiliation(s)
- Pierce W. McMahon
- Department of Radiology, Weill Cornell Medicine, New York City, New York, United States,
| | - Joshua Loewenstern
- Department of Radiology, Weill Cornell Medicine, New York City, New York, United States,
| | - Peter Girgis
- Department of Neurology, Weill Cornell Medicine, New York City, New York, United States,
| | | | - Matthew Fink
- Department of Neurology, Weill Cornell Medicine, New York City, New York, United States,
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Medicine, New York City, New York, United States
| | - Gayle Salama
- Department of Radiology, Weill Cornell Medicine, New York City, New York, United States,
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Ehsanian R, Ali A, Singh H, McKenna SL, Mian MN. Anterior cervical pseudomeningocele causing syncope after spinal surgery: A case report. Int J Surg Case Rep 2022; 91:106789. [PMID: 35093704 PMCID: PMC8802085 DOI: 10.1016/j.ijscr.2022.106789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Pseudomeningocele formation from incidental durotomy is a known risk in spine surgery. We present a case of incidental durotomy leading to anterior neck pseudomeningocele, compressing the carotid body (CB) resulting in syncopal episodes. To our knowledge, this is the first case report implicating syncopal episodes to CB compression via a pseudomeningocele. CASE PRESENTATION A mid sixty-year-old patient with history of obesity, hypertension, and diabetes presented with gait impairment and hand weakness. Ossification of posterior longitudinal ligament (OPLL) was diagnosed with computed tomography imaging (CT) and magnetic resonance imaging (MRI). Elective surgery was completed with an anterior and posterior approach for decompression and fusion. Hospital course (San Jose, CA, USA) was complicated by respiratory depression and incomplete tetraplegia. On post-operative day (POD) six, CT revealed anterolateral soft tissue neck swelling; subsequent CT and MRI showed fluid collection expansion, with associated syncopal episodes on POD thirty-nine. Despite interventional radiology drainage, the fluid collection and symptoms returned five days later. The patient ultimately underwent durotomy revision and repair with muscle patch. CLINICAL DISCUSSION This case highlights the challenges in managing anterior cervical dural tears resulting in pseudomeningocele. Risk factors include anterior cervical corpectomy and decompression, as well as an underlying diagnosis of OPLL. Untreated dural tears may develop into pseudomeningoceles which can contribute to life-threatening outcomes. CONCLUSION This case report presents the serious consequences of incidental durotomy, the unique post-surgical complication of syncope due to compression of the CB from a pseudomeningocele, and the challenges of managing a persistent pseudomeningocele.
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Affiliation(s)
- Reza Ehsanian
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedics & Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Arshad Ali
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Harminder Singh
- Division of Neurosurgery, Santa Clara Valley Medical Center, San Jose, CA, USA; Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen L McKenna
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA; Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Mariam N Mian
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, USA.
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Prod'homme M, Grasset D, Boscherini D. Posterior intraprosthetic dislocation of cervical arthroplasty: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 2:CASE21500. [PMID: 36061081 PMCID: PMC9435578 DOI: 10.3171/case21500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cervical disc herniation is a common condition usually treated with anterior cervical discectomy and fusion (ACDF) or, more recently, with cervical disc arthroplasty (CDA). Both treatments offer similar clinical results. However, CDA has been found to offer fewer medium- to long-term complications as well as potential reduction of long-term adjacent disc degeneration. OBSERVATIONS A 40-year-old man was treated with cervical discectomy and arthroplasty due to a C6-C7 disc herniation with left C7 radiculopathy. After the treatment, his postoperative follow-up appointments were uneventful for 9 months. However, after 9 months, he reported cervical pain and a right C7 radiculopathy after neck extension. Imaging confirmed a posterior intraprosthetic dislocation, the first case reported to date. The patient was received emergency surgery under neuromonitoring, and the prosthesis was replaced by an ACDF and anterior plate. The insert presented a rupture of the anterior horn. The patient presented no preoperative or postoperative neurological deficit, and his follow-up review revealed no issues. LESSONS Posterior intraprosthetic dislocation is an extremely rare complication. It may occur with Mobi-C cervical arthroplasty in the case of rupture and oxidation of the polyethylene insert. Spine surgeons should be aware of this potential major complication.
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Affiliation(s)
- Marc Prod'homme
- Neuro Orthopedic Center, Clinic La Source, Lausanne, VD, Switzerland
| | - Didier Grasset
- Neuro Orthopedic Center, Clinic La Source, Lausanne, VD, Switzerland
| | - Duccio Boscherini
- Neuro Orthopedic Center, Clinic La Source, Lausanne, VD, Switzerland
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Wang ZW, Fan XW, Wang Z, Du PY, Gao XD, Ding WY, Yang DL. Repair of Delayed Meningeal Cyst after Spinal Surgery with Paraspinal Muscle Flap under Microscope. J INVEST SURG 2021; 35:723-730. [PMID: 34039249 DOI: 10.1080/08941939.2021.1924899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Delayed meningeal cyst (DMC) is a rare complication after spinal surgery that is often ignored by clinicians, and its in-depth research is infrequent. In particular, no consensus has been reached about its surgical treatment. We found that patients with a DMC failed after conservative treatment, epidural blood patch, subarachnoid drainage, and initial attempts to eliminate the meningeal cyst. Therefore, we introduce the application of a paraspinal muscle flap repair under a microscope for the treatment of DMC. METHODS In this study, 13 patients who were repaired by a paraspinal muscle flap under a microscope for DMC from January 2007 to January 2017 were retrospectively reviewed. Their ages were 18-68 years old (mean age 48.7 years). The course of the disease ranged from 3 weeks to 28 months after the operation for the primary disease, with an average of 10.6 months. Length >5 cm was called a large DMC and length >8 was called a giant DMC. By analyzing the effect of surgical treatment, we summarized the treatment experience of DMC and evaluated the risk factors for the formation of DMC. RESULTS All patients were treated with paraspinal muscle flap repair under a microscope, and they healed well after the operation. There was no cerebrospinal fluid leakage or other operation-related complication. The mean follow-up was 16.5 months. Reexamination of the spine MRI showed no recurrence of the DMC. CONCLUSIONS The application of paraspinal muscle flap under a microscope combined with glue, bedrest, and CSF drain, was an effective option for the patients with DMC.
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Affiliation(s)
- Zhi-Wei Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Xi-Wen Fan
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Zheng Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Pei-Yu Du
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Xian-Da Gao
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Wen-Yuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China.,Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Shijiazhuang, PR China
| | - Da-Long Yang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China
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Rahimizadeh A, Mohsenikabir N, Asgari N. Iatrogenic lumbar giant pseudomeningocele: A report of two cases. Surg Neurol Int 2019; 10:213. [PMID: 31768293 PMCID: PMC6826298 DOI: 10.25259/sni_478_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/26/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Iatrogenic lumbar pseudomeningoceles are an uncommon complication of lumbar spinal surgeries. This pathology is an extradural, encapsulated, and cerebrospinal fluid collection which develops as a consequence of an inadvertent, unrepaired dural tear. If a pseudomeningocele grows beyond 8 cm in length, it may be classified as “giant.” Case Description: Two adult females with giant pseudomeningoceles due to remote lumbar laminectomy were presented. Both patients were surgically managed. Conclusion: Iatrogenic lumbar giant pseudomeningocele is rare. Notably, their surgical management is similar to that utilized to treat routine pseudomeningoceles.
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Affiliation(s)
- Abolfazl Rahimizadeh
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nima Mohsenikabir
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Naser Asgari
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
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