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Najera E, Bordes SJ, Gailloud P, Gregg L, Martucci M, Obrzut M. Cervical anterior spinal artery infarction associated with anomalous vertebral artery: a case report. Neuroradiology 2024; 66:431-435. [PMID: 38231252 DOI: 10.1007/s00234-023-03277-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/24/2023] [Indexed: 01/18/2024]
Abstract
We report a unique case of cervical anterior spinal artery (ASA) infarction in a 49-year-old male with hypercholesterolemia and sleep apnea. The patient experienced sudden cervical pain, quadriparesis, areflexia, and urinary incontinence after swallowing a large food bolus. Imaging revealed an infarction at the C3-C5 levels and an anomalous right vertebral artery (VA) originating from the thoracic aorta, tightly enclosed between the aorta and a vertebral column with an anterior osteophyte. This aberrant VA was the primary vascular supply to the ASA, with no contribution from the left VA or supreme intercostal arteries. We propose that transient injury to the right VA, induced by compression between the aortic arch, the food bolus, and the osteophyte, led to temporary hypoperfusion of the ASA, causing a watershed ischemic injury in the mid cervical cord's anterior gray matter. The article also provides an in-depth discussion of the developmental and clinical characteristics associated with this rare vascular anomaly.
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Affiliation(s)
- Edinson Najera
- Department of Neurosurgery, Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA
| | - Stephen J Bordes
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Philippe Gailloud
- Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Lydia Gregg
- Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Maria Martucci
- Department of Neurology, Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Michal Obrzut
- Department of Neurosurgery, Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA.
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Petrovic S, Le Forestier N, Pradat PF, Pascal-Moussellard H, Chougar L. Spinal cord ischemia revealed by a Brown-Sequard syndrome and caused by a calcified thoracic disc extrusion with spontaneous regression: a case report and review of the literature. J Med Case Rep 2023; 17:510. [PMID: 38017566 PMCID: PMC10685598 DOI: 10.1186/s13256-023-04208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 10/10/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Thoracic disc herniation is relatively uncommon, accounting for less than 1% of all spinal herniations. Although most often asymptomatic, they may represent a rare cause of spinal cord ischemia. CASE REPORT We report the case of a healthy 43-year-old North African male who presented with a Brown-Sequard syndrome revealing a spinal cord ischemia caused by a thoracic disc extrusion. The initial MRI revealed a calcified disc extrusion at the level of T5-T6 without significant spinal cord compression or signal abnormality. A pattern consistent with a medullary ischemia only appeared 48 h later. The patient was treated conservatively with Aspirin and Heparin, which were discontinued later because of a negative cardiovascular work-up. The calcified disc extrusion, which was later recognized as the cause of the ischemia, decreased spontaneously over time and the patient recovered within a few months. CONCLUSIONS Our case highlights the challenge in diagnosing and managing this uncommon condition. We propose a literature review showing the different therapeutic strategies and their corresponding clinical outcomes.
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Affiliation(s)
- Sonja Petrovic
- Diagnostic Imaging Center, Oncology Institute of Vojvodina, Put Dr Goldmana 4, 21204, Sremska Kamenica, Serbia
| | - Nadine Le Forestier
- Département de Neurologie et Centre SLA IdF. Sorbonne, Département.de Recherche : Études des Sciences et Techniques, Hôpital de La Pitié Salpêtrière, Université, AP-HP. Espaces Régional IdF et National de Réflexion Éthique-Maladies Neuro Évolutives, Université Paris Sud/Paris Saclay, Paris, France
| | - Pierre-François Pradat
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France
- Département de Neurologie, APHP, Hôpital Pitié-Salpêtrière, Centre Référent SLA, Paris, France
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute Ulster University, Altnagelvin Hospital, Derry/Londonderry, C-TRIC, UK
| | - Hugues Pascal-Moussellard
- Sorbonne Université, AP-HP, Hôpital de La Pitié Salpêtrière, Département de Chirurgie Orthopédique, 75013, Paris, France
| | - Lydia Chougar
- DMU DIAMENT, Department of Neuroradiology, Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inria, Inserm, AP-HP, Hôpital de La Pitié Salpêtrière, 75013, Paris, France.
- Centre de NeuroImagerie de Recherche-CENIR, Institut du Cerveau-ICM, Hôpital Pitié-Salpêtrière, 47 Boulevard de L'Hôpital, 75651, Paris Cedex 13, France.
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Nakamura R, Takai K. Small Thoracic Disk Herniation without Spinal Stenosis Presenting with Acute Myelopathy: Three Case Reports. NMC Case Rep J 2023; 10:331-335. [PMID: 38125930 PMCID: PMC10731420 DOI: 10.2176/jns-nmc.2023-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/06/2023] [Indexed: 12/23/2023] Open
Abstract
We herein describe three patients with thoracic disk herniation (TDH) that presented with acute myelopathy at the Tokyo Metropolitan Neurological Hospital between 2014 and 2021 (age range, 45-76 years; male/female ratio = 1:2), with a focus on the mechanisms underlying their development. All patients had sudden-onset gait disturbance due to acute nontraumatic paraparesis. The specialties of the doctors at the first hospital were neurology and orthopedic surgery. TDH was overlooked at the first hospital, and the patients were referred to our hospital. The TDH in all cases was of the central type; however, since they were small, no spinal stenosis was observed. The key feature of all three cases is the small anterior deformation of the spinal cord, making a vascular etiology for the symptoms more plausible than a compressive etiology. After a follow-up of several months or years, two out of three patients underwent surgery with the use of the transfacet pedicle-sparing approach due to residual symptoms. Intraoperative ultrasonography showed that the spinal cord was anchored to TDH by the dural attachment of dentate ligaments. The physical relationship between the dentate ligaments and TDH may be associated with the vascular cause of the symptoms of small TDH.
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Affiliation(s)
- Rika Nakamura
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Keisuke Takai
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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Striano BM, Goh BC, Ziino C, Kim S. Spinal artery syndrome following kyphoplasty in the setting of a non-compressive extradural cement extravasation: a case report. Spinal Cord Ser Cases 2023; 9:18. [PMID: 37185383 PMCID: PMC10130072 DOI: 10.1038/s41394-023-00574-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Cement extravasation (CE) during vertebroplasty or kyphoplasty for vertebral compression fracture (VCF) is not uncommon, though neurological deficits occur rarely and when paraparesis occurs severe cord compression has been described. We report a case of progressive paraparesis in the setting of non-compressive extradural CE during kyphoplasty with evidence for spinal artery syndrome and neurological recovery after treatment. CASE PRESENTATION A 77-year-old female with T12 VCF failed conservative treatment and underwent kyphoplasty. In the recovery room, the patient was noted to have bilateral leg weakness, left worse than right, and had urgent CT scan that showed right paracentral CE without cord compression or arterial cement embolization. The patient was transferred to a tertiary hospital and had MRI of the spine that confirmed extradural CE and no cord compression. Because the patient had progression of lower extremity deficits despite medical management, she underwent surgical decompression, cement excision, and spinal fusion with instrumentation. Post op MRI showed T2 hyperintensities in the spinal cord consistent with spinal artery syndrome. One month post op, she had almost complete recovery of her neurological function. DISCUSSION Spinal artery syndrome may be considered in patients with neurological deficit s/p kyphoplasty even if the extravasated cement does not compress the spinal cord and even if the deficits are worse contralateral to the cement extravasation. If spinal artery syndrome is present and medical management does not improve the deficits, surgery may be indicated even if there is no cord compression.
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Affiliation(s)
- Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Brian C Goh
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Chason Ziino
- Department of Orthopedics, University of Vermont, South Burlington, VT, USA
| | - Saechin Kim
- Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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5
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Symptom distribution and development in thoracic disc surgery – A retrospective case series of 664 patients. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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T3-T4 Disc Herniations: Clinical Presentation, Imaging, and Transaxillary Approach. World Neurosurg 2021; 158:e984-e995. [PMID: 34875390 DOI: 10.1016/j.wneu.2021.11.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe a cohort of T3-T4 thoracic disc herniations (TDHs), their clinical and radiologic characteristics, and unique thoracoscopic transaxillary approach (TAA). METHODS All patients operated on for a T3-T4 TDH with minimal follow-up of 1 year were selected. RESULTS Eight TAA procedures (6 males and 2 females) were included (1.4%). Six patients reported axial pain, irradiating in 2, 4 sensory changes, 1 objective and 1 merely subjective motor weakness. Only 1 TDH was calcified, none was giant, 2 were accompanied by myelomalacia, and 2 by a small segmental syrinx. A cardiothoracic surgeon helped with exposure through a curved axillary incision using anterior cervical and more recently double-ring wound retractors. All patients were operated on using a 10-mm 30° rigid (three-dimensional) high-definition scope. There were no major complications and a good outcome with symptomatic relief in 7 of 8 patients. CONCLUSIONS T3-T4 TDHs are infrequent but may be underdiagnosed because they tend to be small and their signs and symptoms may mimic a cervical problem involving the shoulders and even the arms. There may be a male predominance. The TAA is straightforward, safe, efficacious, and well tolerated despite the supposed vulnerability of the upper thoracic spinal cord. Dissection between large crowded subpleural veins characteristic for the upper thoracic spine and ensuring adequate dura decompression when the steep angle may partially obscure the tip of the instruments does require some extra time. Thorough knowledge of the unique anatomy of the upper thorax is mandatory and the assistance of a cardiothoracic surgeon is highly recommended.
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Marcellino C, Zalewski NL, Rabinstein AA. Treatment of Vascular Myelopathies. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-021-00689-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Aalbers MW, Groen RJM, Appelman APA, Heersema TDJ, Wokke BHA, Oterdoom DLM. Spinal Cord Ischemia Related to Disc Herniation: Case Report and a Review of the Literature. Int Med Case Rep J 2021; 14:429-433. [PMID: 34211300 PMCID: PMC8240129 DOI: 10.2147/imcrj.s316797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/05/2021] [Indexed: 12/01/2022] Open
Abstract
Symptoms of spinal cord ischemia can mimic myelopathy due to spinal cord compression in the acute phase. Thoracic disc herniation with limited spinal cord compression but rapid progression of neurological symptoms causes a clinical dilemma as to whether emergency decompression should be performed. We report a case of acute progressive myelopathy due to spinal cord ischemia related to thoracic disc herniation initially managed by Th8 laminectomy with reduction of the herniated disc. Repeat imaging showed T2-weighted hyperintensity in the posterior cord. The clinical and radiological course supports posterior spinal artery ischemia. This case illustrates and a review of the literature shows that thoracic disc herniation may be complicated by ischemic myelopathy even in the absence of cord compression.
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Affiliation(s)
- Marlien W Aalbers
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Auke P A Appelman
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Thea D J Heersema
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Beatrijs H A Wokke
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D L Marinus Oterdoom
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
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Costamagna G, Meneri M, Abati E, Brusa R, Velardo D, Gagliardi D, Mauri E, Cinnante C, Bresolin N, Comi G, Corti S, Faravelli I. Hyperacute extensive spinal cord infarction and negative spine magnetic resonance imaging: a case report and review of the literature. Medicine (Baltimore) 2020; 99:e22900. [PMID: 33120840 PMCID: PMC7581089 DOI: 10.1097/md.0000000000022900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Spinal cord infarction (SCI) accounts for only 1% to 2% of all ischemic strokes and 5% to 8% of acute myelopathies. Magnetic resonance imaging (MRI) holds a role in ruling out non-ischemic etiologies, but the diagnostic accuracy of this procedure may be low in confirming the diagnosis, even when extensive cord lesions are present. Indeed, T2 changes on MRI can develop over hours to days, thus accounting for the low sensitivity in the hyperacute setting (ie, within 6 hours from symptom onset). For these reasons, SCI remains a clinical diagnosis. Despite extensive diagnostic work-up, up to 20% to 40% of SCI cases are classified as cryptogenic. Here, we describe a case of cryptogenic longitudinally extensive transverse myelopathy due to SCI, with negative MRI and diffusion-weighted imaging at 9 hours after symptom onset. PATIENT CONCERNS A 51-year-old woman presented to our Emergency Department with acute severe abdominal pain, nausea, vomiting, sudden-onset of bilateral leg weakness with diffuse sensory loss, and paresthesias on the trunk and legs. DIAGNOSES On neurological examination, she showed severe paraparesis and a D6 sensory level. A 3T spinal cord MRI with gadolinium performed at 9 hours after symptom onset did not detect spinal cord alterations. Due to the persistence of a clinical picture suggestive of an acute myelopathy, a 3T MRI of the spine was repeated after 72 hours showing a hyperintense "pencil-like" signal mainly involving the grey matter from T1 to T6 on T2 sequence, mildly hypointense on T1 and with restricted diffusion. INTERVENTIONS The patient was given salicylic acid (100 mg/d), prophylactic low-molecular-weight heparin, and began neuromotor rehabilitation. OUTCOMES Two months later, a follow-up neurological examination revealed a severe spastic paraparesis, no evident sensory level, and poor sphincteric control with distended bladder. LESSONS Regardless of its relatively low frequency in the general population, SCI should be suspected in every patient presenting with acute and progressive myelopathic symptoms, even in the absence of vascular risk factors. Thus, a clinical presentation consistent with a potential vascular syndrome involving the spinal cord overrides an initially negative MRI and should not delay timely and appropriate management.
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Affiliation(s)
- Gianluca Costamagna
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
| | - Megi Meneri
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Elena Abati
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
| | - Roberta Brusa
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Daniele Velardo
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Delia Gagliardi
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
| | - Eleonora Mauri
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
| | - Claudia Cinnante
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
| | - Nereo Bresolin
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Giacomo Comi
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Stefania Corti
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neurology Unit
| | - Irene Faravelli
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan
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Stember DM, Hanson RM, Staudinger R. Spinal cord infarction in degenerative cervical spondylosis: An underdiagnosed phenomenon? Neurol Clin Pract 2020; 10:e33-e34. [PMID: 32983621 DOI: 10.1212/cpj.0000000000000743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/22/2019] [Indexed: 11/15/2022]
Affiliation(s)
| | - Richard M Hanson
- Department of Neurology, NYU School of Medicine and Veterans Affairs NYHHS
| | - Robert Staudinger
- Department of Neurology, NYU School of Medicine and Veterans Affairs NYHHS
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Butenschoen VM, Hoenikl L, Deschauer M, Meyer B, Gempt J. Bilateral thoracic disc herniation with abdominal wall paresis: a case report. Acta Neurochir (Wien) 2020; 162:2055-2059. [PMID: 32500255 PMCID: PMC8203549 DOI: 10.1007/s00701-020-04431-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/26/2020] [Indexed: 11/16/2022]
Abstract
We present a rare case of a patient initially presenting with unilateral abdominal wall bulging and radicular pain caused by a lateral disc herniation at Th11/12, later suffering from a hernia recurrence with bilateral disc prolapse and motor deficits. The patient underwent sequesterectomy via a right hemilaminectomy at Th11, and after 8 weeks, a bilateral sequesterectomy with semirigid fusion Th11/12 was performed. Unilateral motor deficits at the thoracic level have been discussed in case reports; a bilateral disc protrusion with abdominal wall bulging occurring as a recurrent disc herniation has never been described before.
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Affiliation(s)
- Vicki Marie Butenschoen
- School of Medicine, Klinikum rechts der Isar, Neurosurgical Department, Technical University of Munich, Munich, Germany
| | - Lisa Hoenikl
- School of Medicine, Klinikum rechts der Isar, Neurosurgical Department, Technical University of Munich, Munich, Germany
| | - Marcus Deschauer
- School of Medicine, Klinikum rechts der Isar, Neurological Department, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- School of Medicine, Klinikum rechts der Isar, Neurosurgical Department, Technical University of Munich, Munich, Germany
| | - Jens Gempt
- School of Medicine, Klinikum rechts der Isar, Neurosurgical Department, Technical University of Munich, Munich, Germany
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12
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Gupta M, Chhabra HS. Nucleus Polposus Embolism Causing Anterior Spinal Artery Occlusion: A Rare but Possible Cause of Fibrocartilaginous Embolic Myelopathy. Int J Spine Surg 2020; 14:391-396. [PMID: 32699762 DOI: 10.14444/7051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Fibrocartilaginous embolic myelopathy (FCEM) is a rare cause of spinal cord infarction. It has been confirmed by autopsy in postmortem cases. Herein we describe a case of FCEM diagnosed based on clinical grounds. Methods A 58-year-old man presented with acute onset of complete paraplegia with bladder and bowel involvement developing a few hours after a trivial trauma. There were no upper motor neuron signs. His magnetic resonance imaging (MRI) was suggestive of longitudinally extensive transverse myelitis from T5 to the conus. There was left paracentral disc protrusion at the T4-T5 level. However, no features of inflammatory, infectious, or autoimmune etiology were found on history, on examination, or in blood or cerebrospinal fluid analysis, and there was no contrast enhancement on MRI. Results A diagnosis of anterior spinal artery occlusion was made based on clinical examination with sparing of posterior column sensations in the lower limbs, predominant involvement of anterior half of the spinal cord on MRI, and accompanying new onset of back pain with rapid symptom progression to nadir as opposed to inflammatory etiology. Fibrocartilaginous embolism was suspected after ruling out all other causes of vascular compromise and presence of disc herniation at T4-T5. He was managed with rehabilitation and showed no signs of recovery. Conclusion FCEM, though rare, should be kept in mind as a differential diagnosis of acute medical myelopathy when no other cause can be identified.
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Affiliation(s)
- Mayank Gupta
- Department of Spine Surgery, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, Delhi, India, PIN 110070
| | - Harvinder Singh Chhabra
- Department of Spine Surgery, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, Delhi, India, PIN 110070
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13
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Pennington Z, Jiang B, Westbroek EM, Cottrill E, Greenberg B, Gailloud P, Wolinsky JP, Lum YW, Theodore N. Retroperitoneal approach for the treatment of diaphragmatic crus syndrome: technical note. J Neurosurg Spine 2020; 33:114-119. [PMID: 32197244 DOI: 10.3171/2020.1.spine191455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Myelopathy selectively involving the lower extremities can occur secondary to spondylotic changes, tumor, vascular malformations, or thoracolumbar cord ischemia. Vascular causes of myelopathy are rarely described. An uncommon etiology within this category is diaphragmatic crus syndrome, in which compression of an intersegmental artery supplying the cord leads to myelopathy. The authors present the operative technique for treating this syndrome, describing their experience with 3 patients treated for acute-onset lower-extremity myelopathy secondary to hypoperfusion of the anterior spinal artery. METHODS All patients had compression of a lumbar intersegmental artery supplying the cord; the compression was caused by the diaphragmatic crus. Compression of the intersegmental artery was probably producing the patients' symptoms by decreasing blood flow through the artery of Adamkiewicz, causing lumbosacral ischemia. RESULTS All patients underwent surgery to transect the offending diaphragmatic crus. Each patient experienced substantial symptom improvement, and 2 patients made a full neurological recovery before discharge. CONCLUSIONS Diaphragmatic crus syndrome is a rare or under-recognized cause of ischemic myelopathy. Patients present with episodic acute-on-chronic lower-extremity paraparesis, gait instability, and numbness. Angiography confirms compression of an intersegmental artery that gives rise to a dominant radiculomedullary artery. Transecting the offending diaphragmatic crus can produce complete resolution of neurological symptoms.
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Affiliation(s)
- Zach Pennington
- 1Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Bowen Jiang
- 1Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Erick M Westbroek
- 1Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ethan Cottrill
- 1Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Benjamin Greenberg
- 2Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Philippe Gailloud
- 3Division of Interventional Neuroradiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jean-Paul Wolinsky
- 4Department of Neurosurgery, Northwestern University, Chicago, Illinois; and
| | - Ying Wei Lum
- 5Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nicholas Theodore
- 1Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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14
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Soda C, Faccioli F, Marchesini N, Ricci UM, Brollo M, Annicchiarico L, Benato C, Tomasi I, Pinna GP, Teli M. Trans-thoracic versus retropleural approach for symptomatic thoracic disc herniations: comparative analysis of 94 consecutive cases. Br J Neurosurg 2020; 35:195-202. [PMID: 32558605 DOI: 10.1080/02688697.2020.1779660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The authors illustrate their results in the surgical treatment of symptomatic thoracic disc herniations (TDHs) by comparing the traditional open to the less invasive retropleural lateral approaches. METHODS Retrospective review of 94 consecutive cases treated at a single Institution between 1988 and 2014. Fifty-two patients were males, 42 females, mean age was 53.9 years. Mean follow-up was 46.9 months (12-79 months). 33 patients were diagnosed with a giant thoracic disc herniation (GTDH). Upon admission, the most common symptoms were: motor impairment (91.4%, n = 86), neuropathic radicular pain with VAS > 4 (50%), bladder and bowel dysfunction (57.4% and 41.4% respectively) and sensory disturbances (29.7%). The surgical approach was based upon level, laterality and presence or absence of calcified lesions. RESULTS Decompression was performed in 7 cases via a thoraco-laparo-phrenotomy and in 87 cases via an antero-lateral thoracotomy. Out of the latter cases, 49 (56%) were trans-thoracic trans-pleural approaches (TTA) and 38 (44%) were less invasive retropleural approaches (MIRA). At follow-up, there were 59.5% neurologically intact patients according to the McCormick Scale, while 64.8% and 67% had no bladder or bowel dysfunction respectively. Complications occurred in 24 patients (25.5%). Pulmonary complications were the commonest (12.7%) with pleural effusion being significantly more common in patients treated with TTA compared to MIRA (20% vs 5.2%: X2 4.13 P:0.042). Severe post-operative neuralgia (VAS 7-10) was also significantly more frequent in the TTA group (22.4% vs 2.6% X2 7.07 p 0.0078). CONCLUSIONS MIRA is a safe and effective technique to obtain adequate TDH decompression and is associated with lower morbidity compared to TTA.
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Affiliation(s)
- Christian Soda
- Department of Neurosurgery, Verona Borgo Trento Hospital, Verona, Italy
| | - Franco Faccioli
- Department of Neurosurgery, Verona Borgo Trento Hospital, Verona, Italy
| | - Nicolò Marchesini
- Department of Neurosurgery, Verona Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Umberto M Ricci
- Department of Neurosurgery, Verona Borgo Trento Hospital, Verona, Italy
| | - Marco Brollo
- Department of Neurosurgery, Mestre Hospital, Mestre, Italy
| | | | - Cristiano Benato
- Department of Thoracic Surgery, Borgo Trento Hospital, Verona, Italy
| | - Ivan Tomasi
- Department of Emergency General Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Marco Teli
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, UK
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Bahadır S, Nabi V, Adhikari P, Ayhan S, Acaroglu E. Anterior Spinal Artery Syndrome: Rare Precedented Reason of Postoperative Plegia After Spinal Deformity Surgery: Report of 2 Cases. World Neurosurg 2020; 141:203-209. [PMID: 32502625 DOI: 10.1016/j.wneu.2020.05.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complications in spinal deformity surgery vary from insignificant to severe. Apart from direct mechanical insult, ischemia can also cause spinal cord injury. Ischemic injury may be detected during surgery or may manifest itself postoperatively. We present 2 cases of anterior spinal artery syndrome. CASE DESCRIPTION In the first case, a 12-year-old girl developed anterior spinal artery syndrome resulting in total quadriplegia 8 hours after spinal deformity surgery. She was treated with a steroid, immunoglobulin, and low-molecular-weight heparin. She showed complete recovery at 1 year postoperatively both clinically and radiographically. In the second case, a 62-year-old woman experienced sudden loss of motor evoked potentials intraoperatively during dural tear repair after sagittal and coronal alignment was established. The paraplegic patient was diagnosed with anterior spinal artery syndrome at the thoracic level postoperatively. She was treated with a steroid and heparin. At 1 year postoperatively, she has gained much of her strength and has myelomalacia in her spinal cord. CONCLUSIONS Anterior spinal artery syndrome is a serious condition with a generally poor prognosis. Though treatment should be directed at the underlying cause, the best strategy is to prevent it from occurring. Peroperative blood pressure control, intraoperative neuromonitoring, avoidance from mechanical stress during surgery, and close neurologic and hemodynamic monitorization postoperatively should be performed.
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Affiliation(s)
- Sinan Bahadır
- ARTES Spine Center, Acibadem Ankara Hospital, Ankara, Turkey
| | - Vugar Nabi
- ARTES Spine Center, Acibadem Ankara Hospital, Ankara, Turkey
| | | | - Selim Ayhan
- ARTES Spine Center, Acibadem Ankara Hospital, Ankara, Turkey
| | - Emre Acaroglu
- Orthopedic Spine Section, Ankara Spine Center, Ankara, Turkey.
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Anterior spinal artery syndrome caused by thoracic disc herniation. J Clin Neurosci 2020; 77:211-212. [PMID: 32409217 DOI: 10.1016/j.jocn.2020.05.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/03/2020] [Indexed: 11/23/2022]
Abstract
We present a case of a midline thoracic disc herniation causing acute anterior spinal artery (ASA) syndrome successfully managed surgically. A 54-year-old female with no significant past medical history presented with sudden onset severe back pain followed by rapidly evolving paraparesis with urinary and bowel incontinence. Her neurological exam was consistent with ASA syndrome. An MRI revealed T2 signal change in the thoracic spinal cord and midline disc herniation at the level of T8/T9. Spinal angiography revealed an ASA arising the right T11 segmental artery with no flow towards the T8/T9 region. The patient underwent a T8/T9 discectomy with a lateral interbody fusion that resulted in dramatic clinical improvement. A postoperative angiogram confirmed improvement of flow in the ASA. This is the first report of an angiographically confirmed symptomatic ASA syndrome caused by a thoracic disc herniation successfully managed with up-front surgery.
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Zalewski NL, Rabinstein AA, Krecke KN, Brown RD, Wijdicks EFM, Weinshenker BG, Kaufmann TJ, Morris JM, Aksamit AJ, Bartleson JD, Lanzino G, Blessing MM, Flanagan EP. Characteristics of Spontaneous Spinal Cord Infarction and Proposed Diagnostic Criteria. JAMA Neurol 2019; 76:56-63. [PMID: 30264146 DOI: 10.1001/jamaneurol.2018.2734] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Spinal cord infarction (SCI) is often disabling, and the diagnosis can be challenging without an inciting event (eg, aortic surgery). Patients with a spontaneous SCI are often misdiagnosed as having transverse myelitis. Diagnostic criteria for SCI are lacking, hindering clinical care and research. Objective To describe the characteristics of spontaneous SCI and propose diagnostic criteria. Design, Setting, and Participants An institution-based search tool was used to identify patients evaluated at Mayo Clinic, Rochester, Minnesota, from January 1997 to December 2017 with a spontaneous SCI. Patients provided written consent to use their records for research. Participants were 18 years and older with a diagnosis of spontaneous SCI (n = 133), and controls were selected from a database of alternative myelopathy etiologies for validation of the proposed diagnostic criteria (n = 280). Main Outcomes and Measures A descriptive analysis of SCI was performed and used to propose diagnostic criteria, and the criteria were validated. Results Of 133 included patients with a spontaneous SCI, the median (interquartile range) age at presentation was 60 (52-69) years, and 101 (76%) had vascular risk factors. Rapid onset of severe deficits reaching nadir within 12 hours was typical (102 [77%]); some had a stuttering decline (31 [23%]). Sensory loss occurred in 126 patients (95%), selectively affecting pain/temperature in 49 (39%). Initial magnetic resonance imaging (MRI) spine results were normal in 30 patients (24%). Characteristic MRI T2-hyperintense patterns included owl eyes (82 [65%]) and pencil-like hyperintensity (50 [40%]); gadolinium enhancement (37 of 96 [39%]) was often linear and located in the anterior gray matter. Confirmatory MRI findings included diffusion-weighted imaging/apparent diffusion coefficient restriction (19 of 29 [67%]), adjacent dissection/occlusion (16 of 82 [20%]), and vertebral body infarction (11 [9%]). Cerebrospinal fluid showed mild inflammation in 7 of 89 patients (8%). Diagnostic criteria was proposed for definite, probable, and possible SCI of periprocedural and spontaneous onset. In the validation cohort (n = 280), 9 patients (3%) met criteria for possible SCI, and none met criteria for probable SCI. Conclusions and Relevance This large series of spontaneous SCIs provides clinical, laboratory, and MRI clues to SCI diagnosis. The diagnostic criteria proposed here will aid clinicians in making the correct diagnosis and ideally improve future care for patients with SCI. The validation of these criteria supports their utility in the evaluation of acute myelopathy.
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Affiliation(s)
| | | | - Karl N Krecke
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | | - J D Bartleson
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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Revision surgery in thoracic disc herniation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:39-46. [PMID: 31734804 DOI: 10.1007/s00586-019-06212-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Surgical treatment failures or strategies for the reoperation of residual thoracic disc herniations are sparsely discussed. We investigated factors that led to incomplete disc removal and recommend reoperation strategies. METHODS As a referral centre for thoracic disc disease, we reviewed retrospectively the clinical records and imaging studies before and after the treatment of patients who were sent to us for revision surgery for thoracic disc herniation from 2013 to 2018. RESULTS A total of 456 patients were treated from 2013 to 2018 at our institution. Twenty-one patients had undergone previously thoracic discectomy at an outside facility and harboured residual, incompletely excised and symptomatic herniated thoracic discs. In 12 patients (57%), the initial symptoms that led to their primary operation were improved after the first surgery, but recurred after a mean of 2.8 years. In seven patients (33%) they remained stable, and in two cases they were worse. All patients were treated via all dorsal approaches. In all 21 cases, the initial excision was incomplete regarding medullar decompression. All of the discs were removed completely in a single revision procedure. After mean follow-up of 24 months (range 12-57 months), clinical neurological improvement was demonstrated in seven patients, while three patients suffered a worsening and 11 patients remained stable. CONCLUSION Our data suggest that pure dorsal decompression provides a short relief of the symptoms caused by spinal cord compression. Progressive myelopathy (probably due to mechanical and vascular deficits) and scar formation may cause worsening of symptoms. These slides can be retrieved under Electronic Supplementary Material.
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Peng T, Zhang ZF. Anterior Spinal Artery Syndrome in a Patient with Cervical Spondylosis Demonstrated by CT Angiography. Orthop Surg 2019; 11:1220-1223. [PMID: 31680448 PMCID: PMC6904664 DOI: 10.1111/os.12555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/27/2019] [Accepted: 09/18/2019] [Indexed: 12/13/2022] Open
Abstract
A few published reports have described anterior spinal artery syndrome (ASAS) with cervical spondylosis based on clinical presentation and/or MRI study, but no photographs of anterior spinal arteries were provided in these studies. Here we present a case of ASAS with cervical spondylosis in a CT angiography (CTA) study. A previously healthy 31‐year‐old man was diagnosed with acute ASAS with cervical spondylosis. Neurological examination revealed four‐limb weakness predominant in the distal part of the upper limbs and superficial sensory impairment below the cervical region. T2‐weighted images on MRI showed an area of hyperintensity in the gray matter of the cervical cord from C3 to C5 with a disc herniation at the C4,5 vertebral level. CTA demonstrated that ASA was occluded at level C4,5, which coincided with the location of disc herniation. Anterior spinal cord decompression and fusions were performed. The patient tolerated the procedure well and had complete resolution of his exertionally dependent myelopathic symptoms 1 week later. In conclusion, although ASAS with cervical spondylosis is rare, it can be diagnosed based on clinical symptoms and MRI and identified by CTA of ASA. A good neurological prognosis is anticipated after anterior spinal cord decompression and fusion is performed if disc herniation is responsible for ASA occlusion.
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Affiliation(s)
- Ting Peng
- Department of Orthopaedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zheng-Feng Zhang
- Department of Orthopaedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Transforaminal Percutaneous Endoscopic Decompression for Lower Thoracic Spinal Stenosis. World Neurosurg 2019; 128:e504-e512. [DOI: 10.1016/j.wneu.2019.04.186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/19/2022]
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The incidence and most common levels of thoracic degenerative disc pathologies. Turk J Phys Med Rehabil 2018; 64:155-161. [PMID: 31453506 DOI: 10.5606/tftrd.2018.1302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 06/15/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives In this study, we aimed to describe and characterize the incidence of thoracic degenerative disc pathologies, bulging/herniation, and the most common affected levels. Patients and methods Between January 2008 and May 2012, a total of 195 patients (109 females, 86 males; mean age 43.5 years; range, 15 to 74 years) who were admitted with the complaint of dorsalgia and underwent magnetic resonance imaging (MRI) of the thoracic vertebral column were included in the study. Data including MRI findings, endplate and disc degeneration, disc height loss, bulging, and disc herniation were retrospectively analyzed. Results Of 3,348 patients, 195 patients had disc bulging/herniation. When 12 levels in 195 cases were taken into consideration, disc pathologies were found in 412 (18%) levels among the total of 2,340 intervertebral disc levels. Bulging was present in 11% (244/2,340) of the levels. Disc herniation was present in 7% (168/2,340) of the levels. The most commonly affected site was T7-8, followed by T8-9 and T11-12. Conclusion Thoracic disc pathologies are still a significant diagnostic challenge. Our study results show that the incidence of these pathologies is higher than expected.
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Zalewski NL, Rabinstein AA, Krecke KN, Brown RD, Wijdicks EF, Weinshenker BG, Doolittle DA, Flanagan EP. Spinal cord infarction: Clinical and imaging insights from the periprocedural setting. J Neurol Sci 2018; 388:162-167. [DOI: 10.1016/j.jns.2018.03.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/04/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
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Kobayashi K, Narimatsu N, Oyoshi T, Ikeda T, Tohya T. Spinal cord infarction following epidural and general anesthesia: a case report. JA Clin Rep 2018; 3:42. [PMID: 29457086 PMCID: PMC5804627 DOI: 10.1186/s40981-017-0109-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/17/2017] [Indexed: 12/15/2022] Open
Abstract
Background Epidural anesthesia is widely used for postoperative analgesia and rarely causes permanent neurological complications. We report a case of paraplegia following abdominal surgery under combined epidural/general anesthesia. Case presentation A 75-year-old woman underwent a scheduled abdominal total hysterectomy and bilateral salpingo-oophorectomy for suspected endometrial cancer. In the operating room, an epidural catheter was inserted at T11/12 while the patient was conscious. The needle entered smoothly, with no observed bleeding, paresthesia, or pain, and general anesthesia was induced. During surgery, 4 mL of 0.25% levobupivacaine and 0.1 mg of fentanyl were administered via the epidural catheter, and a solution of 2.5 μg/mL fentanyl and 0.2% levobupivacaine was continuously infused at 4 mL/h for postoperative analgesia. The patient promptly regained consciousness and could move her bilateral lower extremities without difficulty upon leaving the operating room. During the first postoperative night, she complained of an absence of sensation and weakness in the lower extremities. By the morning of the second postoperative day, she had developed paralysis and sensory losses associated with touch, temperature, pinprick, and vibration below T5. The epidural infusion was stopped. Magnetic resonance imaging (MRI) revealed a hyperintense area of the thoracic cord from T8 to T11, and spinal cord infarction was suspected. Ossification of the yellow spinal ligaments between T11 and T12, resulting in thoracic canal stenosis and thoracic spinal cord compression, were observed. Notably, the epidural catheter was inserted at the same site where the thoracic canal stenosis was present. Conclusions Permanent neurological complications of epidural anesthesia are rare. Studies of neurological complications after epidural/spinal anesthesia have noted the possibility of spinal anomalies, such as lumbar stenosis, in relation to neurological complications after epidural/spinal anesthesia. In this case, the onset of spinal cord infarction may have occurred coincidentally with catheter insertion into the site of existing spinal stenosis. Therefore, it is important to evaluate lower extremity symptoms and consider spinal disease before administering epidural anesthesia. Spinal cord infarction may be prevented by preoperatively identifying spinal lesions using computed tomography or MRI in cases of suspected spinal disease.
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Affiliation(s)
- Kaori Kobayashi
- 1Department of Anesthesiology, Kumamoto Rosai Hospital, 1670, Takehara-machi, Yatsushiro, Kumamoto Japan
| | - Noriko Narimatsu
- 1Department of Anesthesiology, Kumamoto Rosai Hospital, 1670, Takehara-machi, Yatsushiro, Kumamoto Japan
| | - Takafumi Oyoshi
- 1Department of Anesthesiology, Kumamoto Rosai Hospital, 1670, Takehara-machi, Yatsushiro, Kumamoto Japan
| | - Takashi Ikeda
- 2Department of Orthopedic Surgery, Kumamoto Rosai Hospital, Yatsushiro, Japan
| | - Toshimitsu Tohya
- 3Department of Obstetrics and Gynecology, Kumamoto Rosai Hospital, Yatsushiro, Japan
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Brauge D, Madkouri R, Reina V, Bennis S, Baussart B, Mireau E, Aldea S, Gaillard S. Is There a Place for the Posterior Approach in Cases of Acute Myelopathy on Thoracic Disc Hernia? World Neurosurg 2017; 107:744-749. [DOI: 10.1016/j.wneu.2017.08.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/13/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
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Coronary angiography as a rare cause for incomplete anterior spinal artery syndrome. J Neurol 2017; 264:799-801. [PMID: 28229242 DOI: 10.1007/s00415-017-8418-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
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Spinal cord infarction at the level of ossification of the posterior longitudinal ligament. Spinal Cord Ser Cases 2017; 2:16032. [PMID: 28053773 DOI: 10.1038/scsandc.2016.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/06/2016] [Accepted: 10/09/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION We report a case of acute tetraplegia, without any trauma or symptoms prior to onset, who presented with ossification of the posterior longitudinal ligament (OPLL) in the cervical spine with concomitant spinal cord infarction. CASE PRESENTATION A 64-year-old man with a number of risk factors for vascular disease was admitted to our hospital with progressive motor weakness in the bilateral upper and lower extremities. He had initially felt numbness in his left upper extremity and had no previous neurological symptoms or trauma. The night after the initial symptoms, he developed spastic tetraplegia requiring respiratory support. Computed tomography images of the cervical spine demonstrated the segmental type of OPLL. Spinal cord compression and signal intensity changes were identified at the level of C3/4 on magnetic resonance imaging (MRI). He underwent emergency surgery consisting of posterior decompression with laminoplasty of C3-6. Despite the surgery, the patient's tetraplegia did not improve and he continued to require respirator support. There was still no improvement in his neurological status at 10 days postoperatively, and MRI demonstrated evidence of marked spinal cord infarction. DISCUSSION Mechanical compression of spinal arteries by OPLL and pre-existing vascular compromise had a role in the pathogenesis of spinal cord infarction. Chronic spinal compression may be characterized by 3 important factors, namely an uncommonly devastating clinical course, vascular risk factors and persistent findings on MRI, and these might lead to early diagnosis of spinal cord infarction.
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Acker G, Schneider UC, Grozdanovic Z, Vajkoczy P, Woitzik J. Cervical disc herniation as a trigger for temporary cervical cord ischemia. JOURNAL OF SPINE SURGERY 2016; 2:135-8. [PMID: 27683710 DOI: 10.21037/jss.2016.06.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Disc herniations are only reported in few case reports as a rare cause of acute spinal ischemia. A surgical treatment has not been described so far in these reports with analysis of diffusion weighted magnetic resonance imaging (DWI/MRI) before and after surgery. The aim of our study is to report a case of cervical spinal cord ischemia caused by cervical disc herniation and discuss the literature concerning diagnostic and treatment options. METHODS A 72-year-old female patient developed an acute progressive tetraparesis with emphasis on the upper extremities. MRI showed a disc herniation at the cervical segment 5/6 (C5/6) with consecutive spinal canal stenosis and additional signs of spinal cord ischemia in T2-weighted imaging (T2WI) and DWI reaching from C3 to C5 level. With the MRI being highly suggestive for anterior spinal cord ischemia, we hypothesized that this might be caused by compression of the anterior spinal artery through the significant disc herniation. Therefore, we decided to perform an anterior discectomy and fusion at C5/6 level. RESULTS Following surgery, the patient's symptoms showed immediate regression with complete recovery after two months in correspondence with the normalization in the control MRI scan of cervical cord. CONCLUSIONS Assumedly our patient suffered from a partial anterior spinal artery syndrome, possibly caused by a disc herniation-related compression that was reversible following surgery. This was accompanied by a complete resolution of spinal cord signal abnormalities in T2WI and DWI.
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Affiliation(s)
- Güliz Acker
- Department of Neurosurgery and Center for Stroke research Berlin (CSB), Berlin, Germany
| | - Ulf C Schneider
- Department of Neurosurgery and Center for Stroke research Berlin (CSB), Berlin, Germany
| | - Zarko Grozdanovic
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery and Center for Stroke research Berlin (CSB), Berlin, Germany
| | - Johannes Woitzik
- Department of Neurosurgery and Center for Stroke research Berlin (CSB), Berlin, Germany
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Gunshot wound causing anterior spinal cord infarction due to injury to the artery of Adamkiewicz. Spine J 2016; 16:e603-4. [PMID: 26892374 DOI: 10.1016/j.spinee.2016.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/01/2016] [Accepted: 02/03/2016] [Indexed: 02/03/2023]
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Weidauer S, Nichtweiß M, Hattingen E, Berkefeld J. Spinal cord ischemia: aetiology, clinical syndromes and imaging features. Neuroradiology 2014; 57:241-57. [PMID: 25398656 DOI: 10.1007/s00234-014-1464-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The purpose of this study was to analyse MR imaging features and lesion patterns as defined by compromised vascular territories, correlating them to different clinical syndromes and aetiological aspects. METHODS In a 19.8-year period, clinical records and magnetic resonance imaging (MRI) features of 55 consecutive patients suffering from spinal cord ischemia were evaluated. RESULTS Aetiologies of infarcts were arteriosclerosis of the aorta and vertebral arteries (23.6%), aortic surgery or interventional aneurysm repair (11%) and aortic and vertebral artery dissection (11%), and in 23.6%, aetiology remained unclear. Infarcts occurred in 38.2% at the cervical and thoracic level, respectively, and 49% of patients suffered from centromedullar syndrome caused by anterior spinal artery ischemia. MRI disclosed hyperintense pencil-like lesion pattern on T2WI in 98.2%, cord swelling in 40%, enhancement on post-contrast T1WI in 42.9% and always hyperintense signal on diffusion-weighted imaging (DWI) when acquired. CONCLUSION The most common clinical feature in spinal cord ischemia is a centromedullar syndrome, and in contrast to anterior spinal artery ischemia, infarcts in the posterior spinal artery territory are rare. The exclusively cervical location of the spinal sulcal artery syndrome seems to be a likely consequence of anterior spinal artery duplication which is observed preferentially here.
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Affiliation(s)
- Stefan Weidauer
- Department of Neurology, Sankt Katharinen Hospital, Teaching Hospital of the Goethe - University, Frankfurt / Main, Seckbacher Landstraße 65, D 60389, Frankfurt / Main, Germany,
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