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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.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




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.