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How to perform revision lumbar decompression
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Jacob Hoffman, Ryan Murphy, Mark L. Prasarn, Shah-Nawaz M. Dodwad
The surgeon should carefully review the imaging to note the exact location of the stenosis. Typically, recurrent stenosis occurs at the central-cranial aspect of the index level. However recurrence can also occur at the foraminal and lateral recesses. The presence of bony bridging over the site of the previous laminectomy should be noted. Recognizing if the cranial or caudal spinous processes have been removed can provide insight into anatomical landmarks during the exposure. The level of the dura should be compared to the local bony anatomy to aid the surgeon during dissection to prevent inadvertent dural violation. Presence of a pseudomeningocele on imaging alters the surgeon's treatment plan. Patients with equivocal advanced imaging may benefit from epidural steroid injections, such as interlaminar, transforaminal, or facet joint injections, to serve both diagnostic and therapeutic purposes.
Nerve root entrapment with pseudomeningocele after percutaneous endoscopic lumbar discectomy: A case report
Published in The Journal of Spinal Cord Medicine, 2020
Wei Shu, Haipeng Wang, Hongwei Zhu, Yongjie Li, Jiaxing Zhang, Guang Lu, Bing Ni
Because of the various pathological symptom, pseudomeningocele and CSF fistula are difficult to detect early and to distinguish from abscess, seroma, persistent or recurrent symptoms after discectomy, yet MRI is useful to evaluate a suspected case. Among the pseudomeningocele patients, low back pain, headache and gradually enlarging lump under the skin are common symptoms, which may occur several weeks or months after lumbar surgery. Occasionally, nerve roots and spinal cord may herniate into the sac and induce radicular pain. However, the headache and lump were inapparent for this patient, as relatively intact bone and soft tissue preserved by PELD confined the expansion of pseudomeningocele and CSF fistula. On MRI, pseudomeningocele typically appears as a para-spinal CSF collection which exhibits low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. These collections, usually located adjacent to the thecae sac and the laminectomy site, tend to be irregular, lobulated, or oblong.12 However, MRI imaging does not provide adequate visualization to determine nerve root entrapment. Delayed computerized tomography myelography and CISS imaging may be helpful to detect the dural tear and nerve root entrapment.13
Radiographic assessment of surgical treatment of post-traumatic syringomyelia
Published in The Journal of Spinal Cord Medicine, 2021
Yuping D. Li, Chris Therasse, Kartik Kesavabhotla, Jason B. Lamano, Aruna Ganju
Most of the available literature consists of retrospective case series. Schaan et al. presented their experience of 30 patients treated over a 9-year period; 18 of these patients were treated with shunting.21 Five of these patients were treated by shunting and creation of a pseudomeningocele; an additional 7 were treated solely by creation of a pseudomeningocele. Statistical analysis showed better outcomes with pseudomeningocele formation. Shunt complication rate in this series was as high as 12%; hematoma formation, mechanical disconnection, and infection were all causes of shunt malfunction. The authors recommended pseudomeningocele as a primary preferred surgical treatment for PTS with shunting being reserved for refractory cases.
Cranial nerve palsies due to incidental durotomy in lumbar Spine surgery: a case report
Published in British Journal of Neurosurgery, 2020
Thea Overgaard Wichmann, Sanja Karabegovic, Mikkel Mylius Rasmussen
Cranial nerve palsy is a rare complication of spine surgery. It should be considered in patients with cranial nerve dysfunction subsequent to procedures with risk of ID, even in the absence cerebral MRI abnormalities. We propose surgical closure of the ID as a reasonable treatment in patients with evident pseudomeningocele.