Matsukawa Keitaro, Fujiyoshi Kanehiro, Kobayashi Yoshiomi, Kitagawa Takahiro, Yato Yoshiyuki
Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan.
J Neurosurg Case Lessons. 2025 Aug 18;10(7). doi: 10.3171/CASE25438.
Incidental dural tears are a well-known but potentially serious complication of spinal surgery. The authors present a unique case of delayed cauda equina herniation through an occult dural tear without any evident CSF leakage, emphasizing diagnostic challenges and preventive measures specific to unilateral biportal endoscopy (UBE).
A 60-year-old man underwent UBE decompression for lumbar canal stenosis and experienced immediate symptom relief. However, 3 weeks postoperatively, he developed acute severe radicular pain, initially presumed to be caused by disc herniation. Despite repeated decompression, his symptoms progressively worsened. MRI findings remained nonspecific, without CSF leakage. Exploratory surgery ultimately revealed herniation of the cauda equina through an occult dural tear. Surgical repair led to rapid symptom relief and complete recovery without neurological deficits.
This case highlights the importance of considering dural pathology as a potential cause of intractable postoperative radicular pain, even when perioperative findings are inconclusive. Continuous irrigation can compress the dura, mask small dural tears, or tamponade minor leaks, delaying recognition. Surgeons should be aware that UBE's technical environment carries a risk of undetected dural injuries. Prompt recognition and repair of dural defects are essential to prevent rare but serious complications like cauda equina herniation. https://thejns.org/doi/10.3171/CASE25438.
偶然发生的硬脊膜撕裂是脊柱手术中一种广为人知但可能严重的并发症。作者介绍了一例独特的病例，即马尾通过隐匿性硬脊膜撕裂发生延迟性疝出，且无明显脑脊液漏，强调了诊断挑战以及单侧双通道内镜检查（UBE）特有的预防措施。
一名60岁男性因腰椎管狭窄接受UBE减压手术，术后症状立即缓解。然而，术后3周，他出现急性严重神经根性疼痛，最初推测是由椎间盘突出引起。尽管反复进行减压，其症状仍逐渐恶化。MRI检查结果无特异性，未见脑脊液漏。 exploratory surgery最终发现马尾通过隐匿性硬脊膜撕裂疝出。手术修复后症状迅速缓解，完全康复且无神经功能缺损。
该病例强调了即使围手术期检查结果不明确，也应将硬脊膜病变视为术后顽固性神经根性疼痛潜在原因的重要性。持续冲洗可压迫硬脊膜、掩盖小的硬脊膜撕裂或堵塞轻微渗漏，从而延迟诊断。外科医生应意识到UBE的技术环境存在未被发现的硬脊膜损伤风险。及时识别和修复硬脊膜缺损对于预防马尾疝等罕见但严重的并发症至关重要。https://thejns.org/doi/10.3171/CASE25438 。 （注：原文中“Exploratory surgery”直译为“探索性手术”，结合语境可能是指进一步探查的手术，这里保留英文未翻译，因为不确定更准确的中文表述。）
