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Wang S, Lin X, Guo L, He L, Liu Y, Zhao Y, Zhang J. Validity of evoked potential as biomarker for predicting early neural function changes after thoracic spinal decompression surgery in patients with neurological deficits. 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 2024; 33:924-931. [PMID: 38008871 DOI: 10.1007/s00586-023-07893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To evaluate the validity of intraoperative evoked potential (EP) including motor evoked potential (MEP) and somatosensory evoked potentials (SEP) as a biomarker for predicting neural function changes after thoracic spinal decompression (TSD) surgery. METHOD A consecutive series of 336 TSD surgeries were reviewed between 2010 and 2021 from four spine center. All patients with TSD were divided into 3 groups according to different intraoperative EP results: group 1, EP alerts; group 2, no obvious EP deterioration; group 3, EP improvement compared with baselines. The lower limb Japanese Orthopedic Association (JOA) scores (as well as early and long-term JOA recovery rate) were utilized to quantitatively assess pre- and postoperative neural function change. RESULTS Among the 3 subgroups according to the different EP changes, the early JOA recovery rate (RR%) in the EP improvement group was significantly better than the other two groups (51.3 ± 58.6* vs. 27.5 ± 31.2 and 33.3 ± 43.1; p < 0.01) after 3-month follow-up. The mean MEP and SEP amplitude were from 116 ± 57 µV to 347 ± 71 µV (p < 0.01) and from 1.86 ± 0.24 µV to 2.65 ± 0.29 µV (p < 0.01) between spinal cord pre-decompression and post-decompression. Moreover, multivariate logistic regression analysis revealed that risk factors of EP improvement were duration of symptom (p < 0.001, OR 10.9) and Preop. neurologic deficit degree (p = 0.013, OR 7.46). CONCLUSION The intraoperative EP can predict postoperative neural function changes as a biomarker during TSD. Patient with EP improvement probably has better prognosis for early neural function recovery. The duration of symptom and preoperative neurologic deficit degree may be related to intraoperative EP improvement.
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Affiliation(s)
- Shujie Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Xiangquan Lin
- Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, People's Republic of China
| | - Lanjun Guo
- Neurophysiological Monitoring Service, University of California, San Francisco, CA, USA
| | - Li He
- Department of Orthopedics, Yinchuan Guolong Hospital, Yinchuan, 750001, People's Republic of China
| | - Yong Liu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Yu Zhao
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
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Guna Pratheep K, Sonawane K, Rajasekaran S, Shetty AP, Subramanian BJ, Kanna RM. Transient paraplegia in lumbar spine surgery-a potential complication following erector spinae plane block. 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; 31:3719-3723. [PMID: 34787688 DOI: 10.1007/s00586-021-07059-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/14/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Erector spinae plane block (ESPB) has gained popularity over recent years and is being increasingly used in spine surgery for pain management. To date, no major neurological complications have been reported. We present here two patients who developed transient postoperative paraplegia and discuss the possible causes of this phenomenon. METHODS Patients, who underwent preoperative bilateral ESPB as an adjunct to general anesthesia for elective lumbar spine surgery at our institution between January 2017 and December 2020, were retrospectively identified. Among them, only patients who developed postoperative motor and sensory deficits were finally included. RESULTS Overall, two patients [of 316 who underwent ESPB (0.6%)] developed complete motor and sensory deficits in bilateral lower limbs postoperatively. In both patients, the surgery was uncomplicated. Ninety minutes following recovery from general anesthesia, both patients showed gradual neurological recovery in a distal-to-proximal pattern, with complete motor recovery preceding the sensory improvement. Since the surgical procedure was performed at the cauda equine level, transient paraplegia in these patients could only attributed to ESPB. CONCLUSION Transient paraplegia following ESPB (due to anterior spread of the local anesthetic agent into the epidural space) has never been reported, and both anesthetists and surgeons must be aware of this possible complication.
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Affiliation(s)
- K Guna Pratheep
- Department of Orthopedics and Spine Surgery, Ganga Hospital, Ganga Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Kartik Sonawane
- Department of Anaesthesiology, Ganga Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopedics and Spine Surgery, Ganga Hospital, Ganga Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Ajoy Prasad Shetty
- Department of Orthopedics and Spine Surgery, Traumatology and Spine Surgery, Ganga Hospital, Ganga Medical Center and Hospital, 313, Mettupalayam Road, Coimbatore, 641043, Tamil Nadu, India.
| | | | - Rishi Mugesh Kanna
- Department of Orthopedics and Spine Surgery, Ganga Hospital, Ganga Medical Center and Hospital, Coimbatore, Tamil Nadu, India
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Should asymptomatic cervical stenosis be treated in the setting of progressive thoracic myelopathy? A systematic review of the literature. 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 2021; 31:275-287. [PMID: 34724109 DOI: 10.1007/s00586-021-07046-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/12/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Unlike tandem stenosis of the cervical and lumbar spine, tandem cervical and thoracic stenosis (TCTS) of the spine is less common, and the approach and order of intervention are controversial. We aim to review the literature to evaluate the incidence and interventions for patients with cervical and thoracic stenosis. We provide illustrative cases to demonstrate that thoracic myelopathy in the setting of asymptomatic cervical stenosis can be treated safely. METHODS A systematic review of the literature through electronic databases of PubMed, EMBASE, Web of Science, and Cochrane Library was performed to present the current literature that evaluates TCTS as it relates to incidence and surgical interventions. We also present two cases of patients undergoing operative intervention for thoracic myelopathy in the setting of concurrent cervical stenosis. RESULTS A total of 26 English original studies and case reports were identified. Nine studies evaluated the incidence of TCTS. 20 studies with a total of 168 patients with TCTS presented information on surgical intervention options. There is an overall aggregate incidence of 11.6% (530/4751) based on incidence studies. 165 patients underwent thoracic intervention. Of these patients, 63 patients underwent cervical intervention first, 29 underwent thoracic intervention first, and 73 underwent simultaneous, single-stage intervention. CONCLUSIONS In patients presenting with myelopathy, both cervical and thoracic spine should be evaluated for TCTS. Order of operative intervention is tailored to clinical and radiographic information. In cases of thoracic myelopathy with asymptomatic cervical stenosis, thoracic intervention can be pursued with precautions to prevent further cervical cord injury.
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Krishnan A, Samal P, Mayi S, Degulmadi S, Rai RR, Dave B. Thoracic Spine Stenosis: Does Ultrasonic Osteotome Improve Outcome in Comparison to Conventional Technique? Malays Orthop J 2021; 15:62-69. [PMID: 34429824 PMCID: PMC8381659 DOI: 10.5704/moj.2107.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/25/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION To investigate the efficacy of Ultrasonic Bone Scalpel (UBS) in thoracic spinal stenosis (TSS) in comparison to traditional technique. MATERIAL AND METHODS A total of 55 patients who had undergone conventional surgery (Group A) are compared with 45 patients of UBS (Group B) in TSS. The primary outcome measure of Modified Japanese Orthopaedic Association score (m JOA) with neurological complications and dural injury were assessed. Secondary outcome measures of total blood loss (TBL), time duration of surgery (ORT) and length of hospital stay (LHS) were analysed. RESULTS The pre-operative mJOA score 5.00(4.00-6.00) in the group A and 5.00(4.00-6.00) in the group B improved to 7.00(7.00-8.00) in the group A and 9.00(9.00-10.00) in the group B, respectively (P<0.001) at final average follow-up of 117.55 months for group A and 75.69 months in group B. More significant grade of myelopathy improvement and mJOA recovery rate (RR) were noted in group B. The TBL, ORT and LHS were more favourable in group B as compared to group A (p<0.0001). The group A had 9 (16.36%) neurological deficits compared to 2 (4.44%) in group B (p<0.001). Dural tears occurred in both groups (A=11, B=9). It was more frequent and not repairable in group A but without significant statistical difference. CONCLUSION UBS can reduce neurological deficits and improve outcomes in TSS. Secondarily, reduced blood loss, lesser surgical time and reduced LHS are significant added advantages of this new technology.
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Affiliation(s)
- A Krishnan
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - P Samal
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - S Mayi
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - S Degulmadi
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - R R Rai
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - B Dave
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Ahmedabad, India
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Perna F, Geraci G, Mazzotti A, Stefanini N, Panciera A, Faldini C. Acute Presentation of Lumbar Spinal Stenosis Due to Ossified Ligamentum Flavum: The Possible Role of Spondylolisthesis: A Case Report. JBJS Case Connect 2019; 9:e0039. [PMID: 31211745 DOI: 10.2106/jbjs.cc.18.00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 64-year-old woman with a history of low back pain, presented with acute gait impairment and lower limbs numbness without any history of trauma. Imaging studies revealed ossification of the ligamentum flavum (OLF) at L4-L5 and concomitant spondylolisthesis. Decompression surgery with en-bloc removal including the laminae, the ossified ligamentum flavum, and the medial facet and posterior stabilization was performed resulting in complete immediate recovery. CONCLUSIONS This report is the first to describe a case of an acute nontraumatic presentation of OLF associated with spondylolisthesis. OLF pathogenesis in still unknown, although several factors have been considered. According to the literature, operative treatment has demonstrated to be effective.
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Chen H, Liu H, Wang B, Deng Y, Ding C. A rare, acute neurologic deterioration associated with the overactive autoimmune response of ankylosing spondylitis after cervical laminoplasty: A case report. Medicine (Baltimore) 2018; 97:e11605. [PMID: 30142754 PMCID: PMC6112925 DOI: 10.1097/md.0000000000011605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE We report a rare, acute neurological deterioration after cervical laminoplasty due to post-decompression spinal cord edema associated with ankylosing spondylitis in a 52-year old male patient. The patient was diagnosed with cervical spondylotic myelopathy due to ossification of the posterior longitudinal ligament which was complicated by ankylosing spondylitis. A cervical laminoplasty was performed, adversely resulting in paraparesis and loss of tactile sense. An emergency CT scan following the first laminoplasty revealed that the spinal cord compression due to spinal cord swelling and limited-expansion in cervical canal space. The abnormal pathological state of ankylosing spondylitis may have aggravated spinal cord re-perfusion and increased edema after decompression. PATIENT CONCERNS Paraparesis and loss of tactile sense after the surgery immediately. DIAGNOSES Acute neurological deterioration after cervical laminoplasty. INTERVENTIONS A second emergency surgery was performed to remove the C2-C5 laminae. OUTCOMES Six months later, the patient had experienced slight improvement in neurological function. LESSONS Abnormal spinal cord immune inflammatory reaction associated with ankylosing spondylitis and limited decompression may lead to acute neurological deterioration. The potential overactive inflammatory response following surgery in the patients with autoimmune rheumatoid disease should be carefully considered in spinal surgery. Timely diagnosis and treatment may benefit these patients.
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Affiliation(s)
- Hua Chen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, China
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Wu L, Yang T, Yang C, Yao N, Wang H, Fang J, Xu Y. Delayed neurological deterioration after surgery for intraspinal meningiomas: Ischemia-reperfusion injury in a rat model. Oncol Lett 2015; 10:2087-2094. [PMID: 26622801 PMCID: PMC4579926 DOI: 10.3892/ol.2015.3626] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 07/16/2015] [Indexed: 11/30/2022] Open
Abstract
Delayed neurological deterioration in the absence of direct cord insult following surgical removal and cord decompression is a rare but severe postoperative complication in a small subset of patients with intraspinal meningiomas. To date, the underlying pathophysiology of such a finding remains unclear and ischemia-reperfusion injury (IRI) is considered as the potential etiology in the literature. However, no experimental research has been reported to prove this hypothesis. The present study investigated whether IRI occurs following decompression surgery using an experimental rat model of chronic compressive spinal cord injury (SCI). A chronic spinal cord compression model was developed with various sizes of polymer sheets (mild and severe compression) that were microsurgically implanted underneath the T8-9 laminae, and occurrence of IRI in the spinal cord following decompression was determined by measuring superoxide dismutase (SOD) level and malondialdehyde (MDA) concentration. In the mild compression groups, after decompression SOD activities significantly increased along with a reduction in MDA content compared with the non-decompression group (P<0.05), which exhibited diminishment of lipid peroxidation and relief of the secondary injury. These findings indicated that decompression is effective to improve neurological recovery and may deliver improved outcomes for chronic mild compression of the spinal cord. However, in severe compression groups, after decompression, SOD activities markedly reduced further along with a significant increase in MDA content compared with non-decompression group (P<0.05). The results indicated that lipid peroxidation increased immediately after decompression surgery which resulted from reperfusion of the spinal cord. These findings demonstrated IRI may occur as a result of chronic severe compression of the spinal cord. In clinical practice, sudden cord expansion and reperfusion may have lead to disruption in the blood spinal cord barrier, and triggered a cascade of IRI resulting in postoperative neurologic deterioration. Recognition of this neurological deterioration following removal for intraspinal meningiomas may improve preoperative patient counseling and merits further study for determination of the precise pathophysiology.
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Affiliation(s)
- Liang Wu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Tao Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Chenlong Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Ning Yao
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm 11251, Sweden
| | - Huiliang Wang
- College of Chemistry, Beijing Normal University, Beijing 100875, P.R. China
| | - Jingyi Fang
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P.R. China
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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Yang T, Wu L, Wang H, Fang J, Yao N, Xu Y. Inflammation Level after Decompression Surgery for a Rat Model of Chronic Severe Spinal Cord Compression and Effects on Ischemia-Reperfusion Injury. Neurol Med Chir (Tokyo) 2015; 55:578-86. [PMID: 26119897 PMCID: PMC4628191 DOI: 10.2176/nmc.oa.2015-0022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Delayed neurological deterioration in the absence of direct spinal cord insult following surgical decompression is a severe postoperative complication in patients with chronic severe spinal cord compression (SCC). The spinal cord ischemia-reperfusion injury (IRI) has been verified as a potential etiology of the complication. However, the exact pathophysiologic mechanisms of the decompression-related IRI remain to be defined. In this study, we developed a practical rat model of chronic severe SCC. To explore the underlying role of inflammation in decompression-related IRI, immunoreactivity of pro-inflammatory cytokines including tumor necrosis factor-alpha (TNF-α) and interleukin-1β (IL-1β) before and after decompression were measured. In addition, expression level of TNF-α and IL-1β was examined with Western blot. Immunohistochemical staining showed negative result in gray matters in the sham group and sham-decompression group. In the severe compression group, strong positive staining of TNF-α and IL-1β were found, suggesting a dramatic infiltration of inflammatory cells in gray matters. Furthermore, the severe compression group showed a significant increase in expression level of TNF-α and IL-1β as compared with the sham group (p < 0.05). In the severe compression-decompression group, both immunostaining and Western blot showed significant increase of TNF-α and IL-1β levels in the spinal cord compared with the severe compression group (p < 0.05). The results demonstrated that surgical decompression plays a stimulative role in inflammation through increasing the expression of inflammatory cytokines in the rat model of chronic severe SCC injury. Inflammation may be one of the important pathological mechanisms of decompression-related IRI of chronic ischemia.
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Affiliation(s)
- Tao Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University
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Yang T, Wu L, Deng X, Yang C, Zhang Y, Zhang D, Xu Y. Delayed neurological deterioration with an unknown cause subsequent to surgery for intraspinal meningiomas. Oncol Lett 2015; 9:2325-2330. [PMID: 26137065 DOI: 10.3892/ol.2015.3024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 02/10/2015] [Indexed: 11/06/2022] Open
Abstract
Delayed neurological deterioration in the absence of direct cord insult following surgical decompression is rare, but severe post-operative complication occurs in chronically compressive spinal disorders. In the present study, the clinical medical records and radiological findings of 10 patients who underwent surgical removal of intraspinal meningiomas and then experienced delayed post-operative neurological deterioration were reviewed. The cases are presented with consideration of the possible underlying mechanisms. There were five male and five female patients, with a mean age of 46.8 years. The mean duration of illness from the onset of symptoms to diagnosis was 42.8 months. Seven tumors were located in the thoracic region and three in the cervical region of the spine. The tumors compressed the cord severely and gross total removal was achieved in all cases. Immediately subsequent to the surgery, all patients were able to move all extremities, but the onset of the neurological deterioration occurred at post-operative hours 3-8 in all cases (mean, 5 h post-surgery). In four cases, radiological examination revealed an area of high signal changes intrinsic to the cord on T2-weighted images, but without residual compression. The mean follow-up period was 49.6 months. Nine patients reported a marked recovery in status compared with the pre-operative presentation during the several weeks to months following surgery. The surgical removal of intraspinal meningiomas may lead to delayed and severe neurological deterioration in the post-operative period in the absence of direct mechanical cord insult. Ischemia-reperfusion injury may be one potential etiology of this deterioration. Recognition of the neurological deficit following surgical excision of intraspinal meningiomas may improve pre-operative patient counseling and merits further study for the determination of the precise pathophysiology.
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Affiliation(s)
- Tao Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Liang Wu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Xiaofeng Deng
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Chenlong Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Yan Zhang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Dong Zhang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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Knafo S, Lonjon G, Vassal M, Bouyer B, Lonjon N. Spinal cord compression due to undiagnosed thoracic meningioma following lumbar surgery in an elderly patient: a case report. Orthop Traumatol Surg Res 2013; 99:983-6. [PMID: 24210294 DOI: 10.1016/j.otsr.2013.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 07/03/2013] [Accepted: 08/23/2013] [Indexed: 02/02/2023]
Abstract
As spinal surgery in elderly patients is becoming increasingly frequent, comorbidities likely to be decompensated after such procedures must be kept in mind. We report here the case of an 82-year-old woman who presented rapidly progressive spinal cord compression following lumbar surgery for radiculopathy. Investigations showed a thoracic intradural extramedullary compressive lesion, which after removal turned out to be a meningioma. We suggest that radiculopathy and non-specific degenerative modifications partially masked this lesion, and that lumbar surgery caused this acute neurological deterioration. Therefore, we advice caution in older patients among whom such ambiguous clinical presentation is frequent.
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Affiliation(s)
- S Knafo
- Service de neurochirurgie, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Association des Jeunes Chirurgiens du Rachis (AJCR), 237, rue de Bercy, 75012 Paris, France.
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Transient neurological deficit following midthoracic decompression for severe stenosis: a series of three cases. 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 2013; 22:2057-61. [PMID: 23670822 DOI: 10.1007/s00586-013-2829-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 04/01/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To report three cases of transient perioperative neurological deficit in the absence of direct cord insult following decompression of the severely stenotic thoracic spine. METHODS The clinical and radiographic electronic medical records of three patients who underwent decompression for severe midthoracic stenosis with transient neurological deficits perioperatively were reviewed. The cases are presented with consideration of possible underlying mechanisms and multimodality intraoperative monitoring (IOM) findings. RESULTS Two patients had neurologic changes on IOM and Stagnara wake-up test, the remaining patient had absent motor and sensory potentials at baseline and throughout the case. IOM changes were observed immediately following decompression in the absence of direct cord insult or displacement. Postoperatively all patients experienced neurological motor deficits which presented as complete paralysis of the right lower extremity in two of the patients and the left lower extremity in one patient. The deficit was transient-improvement of motor strength occurred between 1 and 13 months of follow-up in all patients. CONCLUSION Decompression of a severely stenotic region of the thoracic spinal cord may lead to a complete yet transient motor deficit in the perioperative period in the absence of direct mechanical cord insult. Potential etiologies include ischemia-reperfusion injury, microthrombi, and altered perfusion due to internal recoil of spinal cord architecture following decompression. IOM may show conspicuous findings in such events, however, may not be relied upon when baseline potentials are sub-optimal. Recognition of this short-lived neurological deficit following decompression of the severely stenotic thoracic spine will improve preoperative patient counseling and merits further study for determination of the precise pathophysiology.
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Yilmaz M, Kalemci O, Yilmaz H, Palaz NM. Lumbar spinal stenosis in a young individual as a result of ligamantum flavum ossification: A case report. Int J Surg Case Rep 2013; 4:645-7. [PMID: 23774332 DOI: 10.1016/j.ijscr.2013.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 02/19/2013] [Accepted: 02/20/2013] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Symtomatic lumbar ligamantum flavum calcification is quite rare in the young age group. PRESENTATION OF CASE The authors report a case of young adult with diagnosis of lumbar spinal stenosis, presenting with leg pain and neurological deficits. Computerized tomography (CT) scan and magnetic resonance (MR) imaging studies revealed ossification of the ligamantum flavum as the causative factor of the disease and the patient recovered completely after the decompressive operation. DISCUSSION It is emphasized that attention should be given to this rare etiological factor of lumbar spinal stenosis. CONCLUSION Complete relief can be achieved with early and adequate surgery.
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Affiliation(s)
- Murat Yilmaz
- Dokuz Eylul University Medical Faculty, Department of Neurosurgery, Izmir, Turkey.
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Liu FJ, Chai Y, Shen Y, Xu JX, Du W, Zhang P. Posterior decompression with transforaminal interbody fusion for thoracic myelopathy due to ossification of the posterior longitudinal ligament and the ligamentum flavum at the same level. J Clin Neurosci 2013; 20:570-5. [DOI: 10.1016/j.jocn.2012.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/05/2012] [Accepted: 04/14/2012] [Indexed: 11/17/2022]
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Zhang P, Cao JM, Shen Y, Zhang YZ, Ding WY, Xu JX. Transient paraparesis after anterior decompression in a patient with ossification of the cervical posterior longitudinal ligament. Orthop Surg 2010; 2:234-6. [PMID: 22009955 DOI: 10.1111/j.1757-7861.2010.00093.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Peng Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Xu R, Sciubba DM, Gokaslan ZL, Bydon A. Ossification of the ligamentum flavum in a Caucasian man. J Neurosurg Spine 2008; 9:427-37. [PMID: 18976173 DOI: 10.3171/spi.2008.9.11.427] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abnormal ossification of spinal ligaments is a well-known cause of myelopathy in East Asian populations, with ossification of the ligamentum flavum (OLF) and the posterior longitudinal ligament being the most prevalent. In Caucasian populations, OLF is rare, and there has been only 1 documented case of the disease affecting more than 5 spinal levels. In this report, the authors describe the clinical presentation, imaging characteristics, and management of the second published case of a Caucasian man with OLF affecting almost the entire thoracic spine. The literature is then reviewed with regard to OLF epidemiology, pathogenesis, presentation, and treatment.
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Affiliation(s)
- Risheng Xu
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
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