Transdural Spinal Cord Herniation: An Exceptional Complication of Thoracoscopic Discectomy: 2-Dimensional Operative Video
| Autor: | Cédric Barrey, Sylvain Portet, Michael Grelat, Rostom Messerer, Benjamin Pommier |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Brown-Séquard syndrome Hernia medicine.medical_treatment Spinal Cord Diseases 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Discectomy Thoracoscopy medicine Humans Spasticity Diskectomy medicine.diagnostic_test Thoracic cavity business.industry medicine.disease Spinal cord Surgery medicine.anatomical_structure Neurology (clinical) Dura Mater medicine.symptom Paraplegia business 030217 neurology & neurosurgery |
| Zdroj: | Operative neurosurgery (Hagerstown, Md.). 21(1) |
| ISSN: | 2332-4260 |
| Popis: | Thoracic disc herniation is a rare and severe condition, whose treatment may have complications including dural tears. Although benign in most cases, dural tears may induce iatrogenic transdural herniation of the spinal cord. The video demonstrates the diagnosis and surgical treatment of iatrogenic transdural herniation of the spinal cord. Here, we report a case of spinal cord herniation after thorascopic treatment of a thoracic disc herniation (DH). A 28-yr-old male presented with several years of left lower extremity weakness and was found to have a T6-7 DH. He underwent DH resection through video assisted mini-thoracotomy at another institution. In the immediate postoperative period, he developed a Brown-Sequard syndrome with left leg weakness. The surgeon decided not to reoperate and the patient improved with rehabilitation, allowing him to walk again. At 6 mo postop, he experienced sudden neurologic worsening but did not present to our clinic until 6 mo later. At this time, he had near complete paraplegia with bilateral lower extremity spasticity and central neuropathic pain. MRI showed a pseudo-meningocele and features suggesting a lateral spinal cord herniation. After a multidisciplinary meeting, we elected to perform a posterolateral approach with costo-arthro-pediculectomy and durotomy to repair the SC herniation. Immediately postop, the patient had a slight improvement in right lower extremity function, with decreased pain and spasticity. This case shows a transdural SC herniation, a rare complication after resection of DH. It is possible that an unreported or unrecognized dural tear at the time of the initial surgery, combined with the negative pressure of the thoracic cavity, put the patient at risk for this particular complication. The authors state that the patient gave his informed consent. |
| Databáze: | OpenAIRE |
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