Incidental durotomy resulting in a postoperative lumbosacral nerve root with eventration into the adjacent facet joint: illustrative cases.

Autor:	Kelly MJ; 1Department of Spine Surgery, Hospital for Special Surgery, New York, New York; and., Altorfer FCS; 1Department of Spine Surgery, Hospital for Special Surgery, New York, New York; and., Burkhard MD; 1Department of Spine Surgery, Hospital for Special Surgery, New York, New York; and., Huang RC; 1Department of Spine Surgery, Hospital for Special Surgery, New York, New York; and., Cammisa FP; 1Department of Spine Surgery, Hospital for Special Surgery, New York, New York; and., Chazen JL; 2Department of Radiology and Imaging Hospital for Special Surgery, New York, New York.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Case lessons [J Neurosurg Case Lessons] 2024 Apr 22; Vol. 7 (17). Date of Electronic Publication: 2024 Apr 22 (Print Publication: 2024).
DOI:	10.3171/CASE2418
Abstrakt:	Background: Radicular pain after lumbar decompression surgery can result from epidural hematoma/seroma, recurrent disc herniation, incomplete decompression, or other rare complications. A less recognized complication is postoperative nerve root herniation, resulting from an initially unrecognized intraoperative or, more commonly, a spontaneous postoperative durotomy. Rarely, this nerve root herniation can become entrapped within local structures, including the facet joint. The aim of this study was to illustrate our experience with three cases of lumbosacral nerve root eventration into an adjacent facet joint and to describe our diagnostic and surgical approach to this rare complication. Observations: Three patients who had undergone lumbar decompression surgery with or without fusion experienced postoperative radiculopathy. Exploratory revision surgery revealed all three had a durotomy with nerve root eventration into the facet joint. Significant symptom improvement was achieved in all patients following liberation of the neural elements from the facet joints. Lessons: Entrapment of herniated nerve roots into the facet joint may be a previously underappreciated complication and remains quite challenging to diagnose even with the highest-quality advanced imaging. Thus, clinicians must have a high index of suspicion to diagnose this issue and a low threshold for surgical exploration.
Databáze:	MEDLINE
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