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Lor KKH, Decruz J, Ang ML, Pang BC, Yang E. Compressive Postoperative Seromas Causing Delayed Neurological Deterioration Following Cervical Laminectomy and Instrumented Fusion. Cureus 2023; 15:e46326. [PMID: 37916260 PMCID: PMC10617753 DOI: 10.7759/cureus.46326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/03/2023] Open
Abstract
Compressive postoperative seromas in the cervical spine are a rare but significant complication following cervical laminectomy and instrumented fusion. There is a paucity of cases reported in the literature, with a majority of the reported cases attributing seroma formation to the use of recombinant human bone morphogenetic protein-2 (rhBMP-2). In this article, we report four cases of compressive postoperative seroma in the absence of rhBMP-2 use and highlight similarities in their clinical presentations. We postulate that seroma formation is a significant complication of the dead space that results following posterior instrumentation in the cervical spine, with or without the use of rhBMP-2. The typical presentation is one of the gradual delayed neurological deterioration several days following the index surgery and after drain removal. Neurological deterioration can be reversed rapidly with early recognition and drainage of the seroma.
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Affiliation(s)
| | - Joshua Decruz
- Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore, SGP
| | - Mu Liang Ang
- Orthopaedic Surgery, Woodlands Health, Singapore, SGP
| | | | - Eugene Yang
- Neurosurgery, Khoo Teck Puat Hospital, Singapore, SGP
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Butler AJ, Mohile N, Phillips FM. Postoperative Spinal Hematoma and Seroma. J Am Acad Orthop Surg 2023; 31:908-913. [PMID: 37071898 DOI: 10.5435/jaaos-d-22-01022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/16/2023] [Indexed: 04/20/2023] Open
Abstract
Fluid collections after spine surgery are rare complications, although potentially grave, and may be broadly grouped into two major categories. Symptomatic postoperative epidural hematomas have some known risk factors and can present with a widely variable profile of signs and symptoms. Treatment involves emergent surgical evacuation to reduce the risk of permanent neurologic deficit. Postoperative seroma may lead to disruption of wound healing and deep infection and has been associated with the use of recombinant human bone mineral protein. These diagnoses may present diagnostic challenges; thorough understanding of the involved pathophysiology, meticulous clinical evaluation, and radiographic interpretation are critical to appropriate management and optimal outcome.
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Affiliation(s)
- Alexander J Butler
- From the Department of Orthopaedic Surgery, Lenox Hill Hospital Northwell Health, New York, NY (Butler), the Department of Orthopaedic Surgery, University of Miami, Miami, FL (Mohile), and the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Phillips)
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Chen J, Neo EJR, Tan YL. Complete spinal cord injury from postoperative seroma following scoliosis surgery: A case report with favorable ambulatory outcomes after comprehensive rehabilitation. J Spinal Cord Med 2023; 46:337-340. [PMID: 35981136 PMCID: PMC9987742 DOI: 10.1080/10790268.2022.2108661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
CONTEXT Postoperative seroma is a known complication following spine deformity surgery. However, complete spinal cord injury (SCI) due to postoperative seroma is rare. Rehabilitation strategies and outcomes of SCI associated with postoperative seroma have been inadequately described. FINDINGS A 15-year-old female experienced inadvertent durotomy during pinal deformity correction surgery for idiopathic adolescent scoliosis. Despite immediate decompressive laminectomy, she developed complete loss of motor and sensory function with neurological level of injury at T10 immediately following the surgery. Urgent magnetic resonance imaging revealed cord compression due to seroma. Decompressive surgery was performed 48 h later and timely intensive rehabilitation was provided for 3 months, which included the use of robotic-assisted gait training (RAGT) to maximize neurological recovery. She demonstrated impressive improvement from grade A to D on the American Spinal Injury Association Impairment Scale and regained functional ambulation over the 3-month period. We describe a comprehensive rehabilitation program to manage SCI associated with postoperative seroma, entailing the use of a robotic gait device for locomotor training. The progression of the patient's neurological status and functional outcomes was documented accordingly. CONCLUSION/CLINICAL RELEVANCE Complete SCI due to seroma, a surgical complication of corrective scoliosis surgery, is rare. However, prompt postoperative examination should be performed routinely in anticipation of neurological deterioration. Early rehabilitation comprising of gait re-training and the use of RAGT might enhance the lower-limb motor strength and functional recovery.
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Affiliation(s)
- Jing Chen
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Yeow Leng Tan
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
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Kennamer BT, DelPino BJ, Lettieri SC, Gridley DG, Hollingworth AK, Feiz-Erfan I. Blunt traumatic posterior cord syndrome. Spinal Cord Ser Cases 2022; 8:52. [PMID: 35545621 PMCID: PMC9095631 DOI: 10.1038/s41394-022-00485-y] [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: 08/28/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Posterior cord syndrome (PCS) is rare and insufficiently assessed in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). CASE PRESENTATION A 39-year-old male was involved in a motorcycle collision and presented with paresthesia of the entire body, neck pain, subjective right arm weakness, and loss of position sense in all extremities. Imaging of the cervical spine revealed fractures of the upper cervical spine including a teardrop fracture and hangman fracture. Patient underwent anterior cervical interbody fusion and plating and halo orthosis. He ultimately regained near full function. Follow-up imaging clearly depicted the traumatic lesion to the level of the posterior spinal cord. DISCUSSION PCS is uncommon, but may be underdiagnosed. We would like to emphasize the importance of a full neurological exam in order to properly diagnose and manage patients with PCS. Our case is unique since we were able to anatomically delineate the focus of spinal cord injury to the posterior column on follow up MRI at 10 months. Therefore, a delayed MRI obtained sub-acutely may facilitate the anatomical diagnosis of PCS.
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Affiliation(s)
| | | | - Salvatore C Lettieri
- Division of Plastic Surgery, Mayo Clinic, Phoenix, AZ, USA
- Division of Plastic Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
- Creighton University School of Medicine Phoenix, Phoenix, AZ, USA
| | - Daniel G Gridley
- Creighton University School of Medicine Phoenix, Phoenix, AZ, USA
- Department of Radiology, Valleywise Health Medical Center, Phoenix, Arizona, Phoenix, AZ, USA
| | - Alexzandra K Hollingworth
- Creighton University School of Medicine Phoenix, Phoenix, AZ, USA
- Division of Trauma, Valleywise Health Medical Center, Phoenix, AZ, USA
- Department of Surgery, Valleywise Health Medical Center, Phoenix, Arizona, Phoenix, AZ, USA
| | - Iman Feiz-Erfan
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA.
- Creighton University School of Medicine Phoenix, Phoenix, AZ, USA.
- Department of Surgery, Valleywise Health Medical Center, Phoenix, Arizona, Phoenix, AZ, USA.
- Division of Neurosurgery, Valleywise Health Medical Center, Phoenix, AZ, USA.
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Hernandez NS, Wang AY, George K, Singh G, Yang MJ, Kryzanski JT, Riesenburger RI. Post-operative quadriparesis following posterior cervical laminectomy and fusion: A case-series of incidence, risk factors, and management. Clin Neurol Neurosurg 2022; 213:107124. [DOI: 10.1016/j.clineuro.2022.107124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/02/2022] [Accepted: 01/08/2022] [Indexed: 11/03/2022]
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