Gopalakrishnan Sowmya, Far Rena, Veilleux Catherine, Swamy Ganesh, Yang Michael M H
Section of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Section of Orthopedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
J Neurosurg Case Lessons. 2024 Dec 2;8(23). doi: 10.3171/CASE24394.
Percutaneous intradiscal hydrogel injection has been used to treat low-back pain (LBP) due to degenerative disc disease with or without mild radicular pain. Complications from these procedures are underreported. In this case lesson, the authors present a rare case of a patient with herniated intradiscal hydrogel following a minor trauma leading to neurological injury.
A 36-year-old female who had been previously treated with L4-5 and L5-S1 intradiscal hydrogel injections for LBP presented with painful, progressive right-sided lower-extremity weakness after experiencing a twisting trauma. Cross-sectional imaging results revealed a herniated hydrogel-based disc implant in the spinal canal. She underwent an urgent L4-5 laminectomy for decompression and removal of the herniated implant. A large annular defect was noted. Postoperatively, she had resolution of her right leg pain but experienced persistent right foot drop requiring an ankle-foot orthosis.
Herniated intradiscal hydrogel implants can lead to permanent neurological injury. While the risk factors for hydrogel herniation have not been elucidated, they can be related to pre-existing disruptions to the annulus and/or posterior longitudinal ligament, excess volume of hydrogel injection, and insufficient fixation time. Further research is needed to determine the safety and efficacy of this technology. https://thejns.org/doi/10.3171/CASE24394.
经皮椎间盘内水凝胶注射已被用于治疗因椎间盘退变伴或不伴轻度神经根性疼痛引起的下腰痛（LBP）。这些手术的并发症报告不足。在本病例报告中，作者介绍了一例罕见病例，一名患者在轻微创伤后发生椎间盘内水凝胶疝出，导致神经损伤。
一名36岁女性，此前因下腰痛接受过L4-5和L5-S1椎间盘内水凝胶注射治疗，在经历一次扭转创伤后，出现右侧下肢进行性疼痛性无力。横断面成像结果显示椎管内有一个基于水凝胶的椎间盘植入物疝出。她接受了紧急的L4-5椎板切除术以减压并取出疝出的植入物。发现有一个大的环状缺损。术后，她的右腿疼痛消失，但右脚持续下垂，需要佩戴踝足矫形器。
椎间盘内水凝胶植入物疝出可导致永久性神经损伤。虽然水凝胶疝出的危险因素尚未阐明，但可能与椎间盘环和/或后纵韧带先前存在的破坏、水凝胶注射量过多以及固定时间不足有关。需要进一步研究以确定该技术的安全性和有效性。https://thejns.org/doi/10.3171/CASE24394 。
