Mitchell Brendan P, Bianco Jake M, Kim Faith M G, Whitaker M Camden
Department of Orthopaedic Surgery, University of Kansas School of Medicine - Wichita, Wichita, KS, USA.
University of Kansas School of Medicine - Wichita, Wichita, KS, USA.
J Surg Case Rep. 2023 Jun 16;2023(6):rjad341. doi: 10.1093/jscr/rjad341. eCollection 2023 Jun.
Neurologic deficit after lumbar spine surgery is a rare and serious complication that must be promptly diagnosed and treated to avoid long-term neurologic disability. Anterior lumbar interbody fusion (ALIF) is an effective technique for the treatment of recurrent disc herniation and lumbar disc degeneration. This case report describes a 20-year-old female with L5-S1 recurrent disc herniation and lumbar degeneration. She underwent an L5-S1 ALIF complicated by post-operative lower left extremity paralysis. Revision surgery with downsizing of the ALIF cage was performed with normal neuromonitoring throughout the procedure. The patient displayed persistent post-operative neurologic deficits despite no evidence of central or foraminal compression. Patient was later diagnosed with conversion disorder by neurology during her hospitalization. This case report presents the initial diagnosis of conversion disorder after a routine ALIF procedure, which led to surgical re-exploration and prolonged inpatient hospital stay. Psychiatric diagnoses must be considered when neurologic deficits are present with no apparent organic cause.
腰椎手术后的神经功能缺损是一种罕见且严重的并发症，必须及时诊断和治疗，以避免长期神经功能残疾。腰椎前路椎间融合术（ALIF）是治疗复发性椎间盘突出症和腰椎间盘退变的有效技术。本病例报告描述了一名20岁女性，患有L5-S1复发性椎间盘突出症和腰椎退变。她接受了L5-S1 ALIF手术，术后出现左下肢麻痹。在整个手术过程中，通过正常的神经监测进行了ALIF椎间融合器尺寸减小的翻修手术。尽管没有中央或椎间孔受压的证据，但患者术后仍存在持续的神经功能缺损。患者住院期间后来被神经科诊断为转换障碍。本病例报告介绍了常规ALIF手术后转换障碍的初步诊断，这导致了手术再次探查和住院时间延长。当存在神经功能缺损且无明显器质性原因时，必须考虑精神科诊断。
