Department of Spinal Cord Injury Medicine, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA.
Physical Medicine and Rehabilitation Department, Tufts Medical Center, Boston, Massachusetts, USA.
J Spinal Cord Med. 2020 Nov;43(6):892-894. doi: 10.1080/10790268.2018.1550598. Epub 2018 Dec 14.
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. 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. 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.
后索综合征（PCS）是最不常见的不完全性脊髓损伤。后索综合征的表现包括本体感觉和振动觉丧失，这些在通常情况下并不用美国脊髓损伤协会的国际标准神经学分类脊髓损伤（ISNCSCI）检查进行测试，因此很容易被遗漏。脊柱内固定后可能会形成血清肿，导致脊髓受压。本病例描述了一例大型血清肿形成后，行椎板切除术后出现后索综合征的独特表现。一位患者在接受后路椎板切除术后出现共济失调和功能下降。检查发现四肢振动觉和本体感觉丧失，但力量保留。颈椎影像学显示椎板切除部位有大量液体聚集，导致脊髓受压。根据临床表现、影像学和实验室检查，认为该液体聚集为血清肿。该患者入住住院康复病房，功能得到改善，允许出院回家。血清肿是颈椎内固定术后的一种并发症，可导致邻近脊髓受压，导致功能下降。在这种情况下，血清肿导致振动觉和本体感觉丧失，进而导致共济失调，这些症状在 ISNCSCI 检查中通常无法识别；因此，这强调了在评估经历神经功能恶化的脊髓损伤患者时，需要扩大神经系统检查。
