Iida Jumpei, Miyakoshi Naohisa, Hongo Michio, Sasaki Hiroshi, Ito Hiroki, Kubota Hitoshi, Sato Takeshi, Shimada Yoichi
Department of Orthopedic Surgery, Noshiro Kosei Medical Center, Noshiro, Japan.
Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo, Akita, Japan.
Surg Neurol Int. 2021 Jan 20;12:30. doi: 10.25259/SNI_893_2020. eCollection 2021.
Incidental durotomy is a well-known complication of spinal surgery. It can lead to persistent cerebrospinal fluid leakage resulting in significant secondary complications. Here, we present a case in which the cauda equina herniated into a pseudomeningocele that penetrated a facet joint, leading to lower extremity radiculopathy warranting surgical correction.
One year ago, a 67-year-old male underwent a partial left L4-L5 laminectomy. At surgery, a durotomy was repaired with a nylon suture and reinforced with a fat patch. He subsequently presented with severe left lower extremity radiculopathy and a partial cauda equina syndrome. On MR, the cauda equina had herniated into a pseudomeningocele that penetrated the left facet joint. Once the defect was repaired at surgery, the patient's symptoms improved.
It is critical to correctly repair an intraoperative durotomy to avoid further neurological deficits that may include cauda equina herniation into pseudomeningoceles penetrating facet joints.
术中意外硬脊膜切开是脊柱手术中一种众所周知的并发症。它可导致持续性脑脊液漏，进而引发严重的继发性并发症。在此，我们报告一例病例，其中马尾神经疝入一个穿透小关节的假性脑脊膜膨出，导致下肢神经根病，需要进行手术矫正。
一年前，一名67岁男性接受了左侧L4-L5部分椎板切除术。手术中，用尼龙缝线修复硬脊膜切开处，并用脂肪片加固。随后，他出现严重的左下肢神经根病和部分马尾神经综合征。磁共振成像显示，马尾神经疝入一个穿透左侧小关节的假性脑脊膜膨出。手术修复缺损后，患者症状改善。
正确修复术中硬脊膜切开至关重要，以避免可能出现的进一步神经功能缺损，包括马尾神经疝入穿透小关节的假性脑脊膜膨出。
