Dynamic paraspinal muscle impingement causing acute hemiplegia after C1 posterior arch laminectomy: A case report.
|Abstract||Acute neurological deficits following spinal surgery commonly result from epidural hematoma, surgical trauma, vascular compromise, and graft or hardware impingement, with the cause identified by magnetic resonance imaging (MRI). We present a rare case of dynamic paraspinal muscle impingement after C1 posterior arch laminectomy, which was diagnosed by myelography, with no significant findings on MRI.|
Extraordinary positional cervical spinal cord compression in extension position as a rare cause of postoperative progressive myelopathy after cervical posterior laminoplasty detected using the extension/flexion positional CT myelography: one case after laminectomy following failure of a single-door laminoplasty/one case after double-door laminoplasty without interlaminar spacers.
|Publication Year Start||2018-01-01|
PMID- 29390372 OWN - NLM STAT- MEDLINE DCOM- 20180212 LR - 20180212 IS - 1536-5964 (Electronic) IS - 0025-7974 (Linking) VI - 96 IP - 50 DP - 2017 Dec TI - Dynamic paraspinal muscle impingement causing acute hemiplegia after C1 posterior arch laminectomy: A case report. PG - e9264 LID - 10.1097/MD.0000000000009264 [doi] AB - RATIONALE: Acute neurological deficits following spinal surgery commonly result from epidural hematoma, surgical trauma, vascular compromise, and graft or hardware impingement, with the cause identified by magnetic resonance imaging (MRI). We present a rare case of dynamic paraspinal muscle impingement after C1 posterior arch laminectomy, which was diagnosed by myelography, with no significant findings on MRI. PATIENT CONCERNS: An 81-year-old, severely obese male, was referred to our department for the treatment of vertebral disease of the lumbar spine. The patient presented with bilateral weakness and numbness of the upper extremities and gait disturbances. Based on MRI, a diagnosis of retro-odontoid pseudotumor was made, and C1 posterior arch laminectomy, in combination with C4 partial laminectomy and C5 to C6 laminoplasty, was performed. On postoperative day 3, the patient's neurological status deteriorated, with right upper extremity and right lower extremity weakness increasing with neck extension. Although there was no evidence of epidural hematoma formation on MRI, obstruction of the flow of contrast medium by an external posterior compression in neck extension at the level of C1 was identified by myelography. Revision surgery was performed and local muscle swelling at the surgical site identified with no hematoma formation. Occiput to C3 fixation, with instrumentation, was performed. OUTCOMES: Muscle strength of the right upper extremity and lower extremities recovered postsurgery, and the patient has continued to improve function 3 years after surgery, with no further neurological episodes. LESSONS: Dynamic paraspinal muscle impingement following C1 laminectomy in a muscular man was diagnosed by myelography, with no significant findings on standard MRI. CONCLUSION: The possibility of dynamic paraspinal muscle impingement should be considered in patients developing acute, progressive, neurological deficits after posterior cervical decompression, with myelography being the imaging method of choice for diagnosis. CI - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved. FAU - Notani, Naoki AU - Notani N AD - Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan. FAU - Miyazaki, Masashi AU - Miyazaki M FAU - Yoshiiwa, Toyomi AU - Yoshiiwa T FAU - Ishihara, Toshinobu AU - Ishihara T FAU - Kanezaki, Shozo AU - Kanezaki S FAU - Tsumura, Hiroshi AU - Tsumura H LA - eng PT - Case Reports PT - Journal Article PL - United States TA - Medicine (Baltimore) JT - Medicine JID - 2985248R SB - AIM SB - IM MH - Aged, 80 and over MH - Cervical Vertebrae/*surgery MH - Hemiplegia/*etiology MH - Humans MH - Laminectomy MH - Magnetic Resonance Imaging MH - Male MH - Myelography MH - Neurosurgical Procedures MH - Odontoid Process/*surgery MH - Paraspinal Muscles/*surgery MH - Postoperative Complications/*etiology MH - Recovery of Function MH - Spinal Cord Diseases/*diagnosis/*surgery EDAT- 2018/02/03 06:00 MHDA- 2018/02/13 06:00 CRDT- 2018/02/03 06:00 PHST- 2018/02/03 06:00 [entrez] PHST- 2018/02/03 06:00 [pubmed] PHST- 2018/02/13 06:00 [medline] AID - 10.1097/MD.0000000000009264 [doi] AID - 00005792-201712150-00122 [pii] PST - ppublish SO - Medicine (Baltimore). 2017 Dec;96(50):e9264. doi: 10.1097/MD.0000000000009264.