Ogawa Safumi, Inomata Yohei, Yamao Kazuki, Karino Shogo, Watanabe Kazuyuki
Department of Orthopedic Surgery, Iwaki City Medical Center, Iwaki, JPN.
Department of Research for Spine and Spinal Surgery, Fukushima Medical University, Fukushima, JPN.
Cureus. 2025 Aug 6;17(8):e89467. doi: 10.7759/cureus.89467. eCollection 2025 Aug.
Dural tears are a well-known complication of spinal surgery. While most occur intraoperatively and are promptly identified, some are overlooked or develop postoperatively. Delayed-onset dural tears are relatively rare but can result in significant neurological complications, including cauda equina syndrome (CES). We report the case of a 74-year-old woman who developed delayed-onset CES following lumbar decompression surgery. Postoperatively, the patient experienced saddle anesthesia and urinary retention. MRI revealed a hematoma compressing the cauda equina. Emergency reoperation revealed a longitudinal dural tear with herniation and incarceration of the cauda equina. The nerve roots were successfully reduced, and the dural defect was repaired. The patient showed partial neurological recovery postoperatively. In this case, intraoperative dural vulnerability, suction drainage, and increased intrathecal pressure due to straining likely contributed to delayed dural rupture and nerve root herniation. Awareness of this rare but serious complication is essential. MRI findings and clinical symptoms should prompt urgent reoperation if CES is suspected. This rare case of delayed-onset CES due to a dural tear after lumbar surgery was likely precipitated by straining-induced intrathecal pressure. The case underscores the importance of meticulous intraoperative dural inspection, cautious drainage management, and early recognition of postoperative neurological deterioration.
硬脊膜撕裂是脊柱手术中一种众所周知的并发症。虽然大多数硬脊膜撕裂发生在手术过程中且能被及时发现，但有些会被忽视或在术后才出现。迟发性硬脊膜撕裂相对少见，但可导致严重的神经并发症，包括马尾综合征（CES）。我们报告一例74岁女性患者，其在腰椎减压手术后出现迟发性CES。术后，患者出现鞍区麻醉和尿潴留。磁共振成像（MRI）显示有血肿压迫马尾。急诊再次手术发现一处纵向硬脊膜撕裂，伴有马尾疝出和嵌顿。神经根成功复位，硬脊膜缺损得以修复。患者术后神经功能有部分恢复。在本病例中，术中硬脊膜的易损性、吸引引流以及因用力导致的鞘内压力升高可能促成了迟发性硬脊膜破裂和神经根疝出。认识到这种罕见但严重的并发症至关重要。如果怀疑有CES，MRI表现和临床症状应促使紧急再次手术。这例腰椎手术后因硬脊膜撕裂导致迟发性CES的罕见病例可能是由用力引起的鞘内压力升高所致。该病例强调了术中仔细检查硬脊膜、谨慎管理引流以及早期识别术后神经功能恶化的重要性。
