Cervical pseudomeningocele as a cause of tetraparesis after posterior cervical spine surgery: a case report
Keywords:
Cervical pseudomeningocele, Cervical laminectomy, Cervical spondylosis, Postsurgical complicationsAbstract
INTRODUCTION: Postoperative pseudomeningocele secondary to cervical laminectomy is often asymptomatic and resolves spontaneously. Rarely, progressive symptoms develop, from pain, either local or radicular, until loss of muscle strength due to spinal cord compression.
CLINICAL CASE: Male patient, 72 years old with bilateral pain in the neck and brachialgia. Also he refers progressive gait difficult with occasionally stick need and frequent falls. Neurological examination showed spastic tetraparesis. MRI showed degenerative changes from C3 to C7, degenerative disc disease, disc prolapses and osteophyte formation. Cervical laminectomy was performed after the diagnosis of cervical spondylosis and decompensated myelopathy with multisegmental involvement (Nurick grade 4). He was discharged 10 days after surgery without complications, and walking independently. Postoperatively, the patient suffered clinical worsening leading to quadriplegia, and cervical pseudomeningocele with cord compression was diagnosed by MRI later. Lumbar puncture and lumboperitoneal shunt were ineffective, probably due to the establishment of a valve system in the surgical area. Cervical pseudomeningocele dimensions decreased with dural repair and surgical cystoperitoneal bypass, but tetraparesis persist.
CONCLUSIONS: Cervical pseudomeningocele must be considered as a cause of tetraparesis after posterior cervical spine surgery and its importance must not be underestimated. Early treatment of pseudomeningocele is essential for the recovery of neurological defect.
Downloads
References
1. King JT, McGinnis KA, Roberts MS. Quality of life assessment with the medical outcomes study short form–36 among patients with cervical spondylotic myelopathy. Neurosurgery. 2003;52:113–20.
2. Morgan SL, Krishna V, Varma AK. Cervical pseudomeningocele as a cause of neurological decline after posterior cervical spine surgery. Neurol India. 2012;60:256–7.
3. Rahat B, Prasad A, Rana S, Dhingra A, Sharma T. Post–traumatic occipito–cervical pseudomeningocele without any bony injury. Clin Neurol Neurosurg. 2014;120:20–22
4. Couture D, Branch CL. Spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus. 2003;15:E6.
5. Nurboja B, Choi D. Extensive spinal cord oedema and early syrinx formation due to tension pseudomeningocele after foramen magnum decompression. Br J Neurosurg. 2009;23:443–5.
6. Moriyama T, Tachibana T, Maruo K, Inoue S, Okada F, Yoshiya S. Postoperative spinal cord herniation with pseudomeningocele in the cervical spine: a case report. Spine J. 2013;13:e43–5.
7. Macki M, Lo SF, Bydon M, Kaloostian P, Bydon A. Post–surgical thoracic pseudomeningocele causing spinal cord compression. J Clin Neurosci. 2014;21:367–72.
8. Leis AA, Leis JM, Leis JR. Pseudomeningoceles: a role of mechanical compression in the treatment of dural tears. Neurology. 2001;56:1116–7.
9. Avecillas–Chasin JM, Ahmed M, Robles–Hidalgo E, Gómez–Perals L. Surgical management of chronic traumatic pseudomeningocele of the craniocervical junction: case report. Childs Nerv Syst. 2014;30:1125–8.
10. Tan LA, Takagi I, Straus D, O'Toole JE. Management of intended durotomy in minimally invasive intradural spine surgery. J Neurosurg Spine. 2014;21:279–85.
11. Uchida K, Nakajima H, Okazawa H, Kimura H, Kudo T, Watanabie S, et al. Multivariate analysis of the neurological outcome of surgery for cervical compressive myelopathy. J Orthop Sci. 2005;10:564–73.
