Orthopedics. 2023 Nov-Dec;46(6):e384-e386. doi: 10.3928/01477447-20220831-08. Epub 2022 Sep 7.
A 53-year-old man presented to the emergency department with severe lower back pain, saddle anesthesia, and urinary dysfunction. He had undergone endoscopic lumbar interbody fusion for highly migrated lumbar disk herniation and lumbar instability 10 days ago. Emergency computed tomography showed that the bone graft materials had migrated to the sacral canal, and a mass with low intensity was seen located at the end of the dural cavity on T2-weighted magnetic resonance imaging. It was suspected that the bone graft materials had migrated into the dural cavity at the operative level and fallen into the end of the dural cavity due to gravity, causing acute cauda equina syndrome (CES). After emergency durotomy, the bone graft materials were completely removed. At the 18-month follow-up, the patient recovered without further complications. This procedure resulted in a rare case of CES caused by intradural bone graft after endoscopic lumbar interbody fusion. Spine surgeons should be aware of this rare but potentially dangerous complication, especially in water-based endoscopic lumbar interbody fusion. This case report shows that early recognition and prompt treatment can significantly improve the symptoms of CES, including saddle numbness and bladder dysfunction. [. 2023;46(6):e384-e386.].
一位 53 岁男性因严重腰痛、鞍区感觉麻木和排尿功能障碍到急诊就诊。他 10 天前因高位腰椎间盘突出症和腰椎不稳接受了内镜下腰椎椎间融合术。急诊 CT 显示骨移植材料已迁移到骶管，磁共振成像 T2 加权像上可见终池末端有一个低信号的肿块。考虑到骨移植材料可能已迁移到手术水平的硬脊膜内，并因重力落入硬脊膜末端，导致急性马尾综合征（CES）。行紧急硬脊膜切开术后，将骨移植材料完全取出。在 18 个月的随访中，患者未再出现并发症而痊愈。该手术导致了一例罕见的内镜下腰椎椎间融合术后硬脊膜内骨移植引起的 CES。脊柱外科医生应意识到这种罕见但潜在危险的并发症，尤其是在水基内镜下腰椎椎间融合术中。本病例报告表明，早期识别和及时治疗可以显著改善 CES 的症状，包括鞍区麻木和膀胱功能障碍。[J Neurosurg Spine. 2023;46(6):e384-e386.]。
