The Result of Early Decompression of Progressive Neurologic Deficit after Spine Surgery: A Case Report.
10.4184/jkss.2007.14.3.201
- Author:
Dong Ki AHN
1
;
Dea Jung CHOI
;
Song LEE
;
Young Won JEON
;
Seung Jin YANG
Author Information
1. Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea. niceosu@freechal.com
- Publication Type:Case Report
- Keywords:
Progressive neurological deficit. Root entrapment
- MeSH:
Constriction, Pathologic;
Decompression*;
Edema;
Hematoma;
Ischemia;
Neurologic Manifestations*;
Spinal Diseases;
Spinal Stenosis;
Spine*
- From:Journal of Korean Society of Spine Surgery
2007;14(3):201-206
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Two percent of neurological complications after spine surgery for various reasons have been reported. Most are static or improve with time. We encountered two cases of newly developed, progressive neurological deficits with severe pain radiating along the exiting root after posterior decompression, adhesiolysis, posterior lumbar interbody fusion (PLIF) with a cage for spinal stenosis after previous lumbar spine surgery. When explored, the severely tightened and less movable, edematous exiting root was entrapped by a pedicle without evidence of pedicle violation, direct injury, epidural hematoma or iatrogenic foraminal stenosis. A wider decompression with a resection of the pedicle reduced the root course and made it more movable. Immediately, the severe radiating pain subsided and the neurological deficit recovered. A progressive neurological deficit after spinal surgery for spinal diseases with foraminal stenosis can develop as a result of the inordinate manipulation of the root, which may provoke root edema, root self-entrapment around a pedicle and local ischemia. An image test and exploration should be performed immediately in cases of progressive single root neurological deficits immediately after spine surgery. Total decompression, even with a pedicle resection, should be considered to resolve the neurological deficits.
