Raudenbush Brandon L, Molinari Andrew, Molinari Robert W
University of Rochester, Rochester, NY, USA.
Global Spine J. 2017 May;7(3):206-212. doi: 10.1177/2192568217694145. Epub 2017 Jun 16.
Retrospective review.
Large compressive pseudomeningocele causing a major neurologic deficit is a very rare complication that is not well described in the existing literature.
Institutional review board consent was obtained to study 2552 consecutive extradural spinal surgical cases performed by a single senior spinal surgeon during a 10-year period. The surgeon's database for the decade was retrospectively reviewed and 3 cases involving postoperative major neurologic deficits caused by large compressive pseudomeningocele were identified.
The incidence of postoperative compressive pseudomeningocele causing major neurologic deficit was 0.12% (3/2552) per decade of spinal surgery with approximately 1.3% of cases incurring incidental durotomy. Average age of the patients was 57 years (range 45-78). One patient had posterior cervical spine surgery, and 2 patients had posterior lumbar surgery. All 3 patients had intraoperative incidental durotomy repaired during their index procedure. Large compressive pseudomeningocele causing major neurologic deficit occurred in the early 2-week postoperative period in all patients and was clearly identified on postoperative magnetic resonance imaging. All 3 patients were treated with emergent decompression and repair of the dural defect. All patients recovered neurologic function after revision surgery.
Incidental durotomy and repair causing a large compressive pseudomeningocele after spine surgery is a rare and potentially devastating event. Early postoperative magnetic resonance imaging assists in the diagnosis. Emergent decompression combined with revision dural repair surgery may result in improved outcomes. Surgeons should be cognizant of this rare cause of early postoperative major neurologic deficit in patients who had previous dural repair.
回顾性研究。
大型压迫性假性脑脊膜膨出导致严重神经功能缺损是一种非常罕见的并发症，现有文献对此描述不多。
获得机构审查委员会同意，研究一位资深脊柱外科医生在10年期间连续进行的2552例硬膜外脊柱手术病例。回顾该医生十年的数据库，确定3例因大型压迫性假性脑脊膜膨出导致术后严重神经功能缺损的病例。
脊柱手术每十年中，术后因压迫性假性脑脊膜膨出导致严重神经功能缺损的发生率为0.12%（3/2552），约1.3%的病例发生术中硬脊膜切开。患者平均年龄为57岁（范围45 - 78岁）。1例患者接受了颈椎后路手术，2例患者接受了腰椎后路手术。所有3例患者在初次手术中均对术中意外硬脊膜切开进行了修复。所有患者均在术后早期2周内出现导致严重神经功能缺损的大型压迫性假性脑脊膜膨出，术后磁共振成像清晰显示。所有3例患者均接受了紧急减压和硬脊膜缺损修复治疗。所有患者在翻修手术后神经功能均恢复。
脊柱手术后意外硬脊膜切开及修复导致大型压迫性假性脑脊膜膨出是一种罕见且可能具有毁灭性的事件。术后早期磁共振成像有助于诊断。紧急减压联合翻修硬脊膜修复手术可能会改善预后。外科医生应认识到这一导致曾接受硬脊膜修复患者术后早期严重神经功能缺损的罕见原因。
