Department of Physical Medicine and Rehabilitation, Wooridul Spine Hospital, Gimpo Airport, Seoul, Republic of Korea.
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Republic of Korea.
J Int Med Res. 2022 Dec;50(12):3000605221144147. doi: 10.1177/03000605221144147.
We present a case of a dural tear associated with nerve root herniation following unilateral biportal endoscopic decompression (UBED) that was successfully treated using a computed tomography-guided epidural blood patch. A 60-year-old man underwent UBED for radicular pain because of spinal stenosis at L4-5. A left partial hemilaminectomy and flavectomy were performed; however, the left dorsolateral side dura mater was torn during the procedure. TachoComb® was applied at the dural tear site, and the pain was relieved following UBED. However, 3 weeks post-UBED, the patient reported severe pain with an electric shock-like sensation in the left buttock and posterior thigh region with no other neurologic symptoms. The pain was aggravated by standing and spinal motion. Follow-up lumbar spinal magnetic resonance imaging was performed. Axial images indicated protrusion of the left S2 nerve root through the left dorsolateral side of the dura mater. The patient was further diagnosed with nerve root herniation following a dura mater tear. A computed tomography-guided epidural blood patch was performed, with successful therapeutic results. The outcome of this study indicates that a small dural tear that occurs during minimally invasive spinal surgery can be efficiently treated using an epidural blood patch prior to open surgery.
我们报告了一例单侧双通道内镜减压术（UBED）后神经根疝合并硬脊膜撕裂的病例，该病例通过 CT 引导硬膜外血贴成功治疗。一名 60 岁男性因 L4-5 脊柱狭窄症接受 UBED 治疗神经根痛。进行了左侧部分半椎板切除术和黄韧带切除术；然而，在手术过程中左侧背外侧硬脊膜撕裂。在硬脊膜撕裂部位应用了 TachoComb®，UBED 后疼痛缓解。然而，UBED 后 3 周，患者报告左臀部和大腿后侧有严重的电击样疼痛，无其他神经症状。站立和脊柱运动时疼痛加重。进行了随访腰椎磁共振成像。轴向图像显示左侧 S2 神经根通过硬脊膜的左侧背外侧突出。该患者进一步诊断为硬脊膜撕裂后神经根疝。进行了 CT 引导硬膜外血贴，治疗效果良好。本研究结果表明，在微创脊柱手术中发生的小硬脊膜撕裂，可以在开放手术前通过硬膜外血贴有效治疗。
