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An anterior sacral meningocele, a rare congenital anomaly, manifested in a previously healthy 44-year-old woman with findings of meningitis, including headache, vomiting, unconsciousness, and fever. Nontraumatic pneumocephalus, tetraventricular hydrocephalus, fluid-fluid level at the lateral ventricles, and pial enhancement were observed on multidetector computed tomography. A ventricular drainage catheter was placed to decompress the hydrocephalus, and drainage was performed urgently. Escherichia coli was isolated from the drainage material. Whole-spine magnetic resonance imaging and fistulography were undertaken on the third day after admission to evaluate for anal and urinary incontinence and pareses of both upper and lower extremities. Spinal arachnoiditis, tethered cord, dysgenesis of the sacrum, and a rectothecal fistula were demonstrated. Specific antibiotic treatment and surgery for fistula tract excision were performed.

CSF hydrothorax following V/P shunt surgery is a very rare complication that may cause serious respiratory distress. It is important to keep in mind that peritoneal catheter migration into the chest may or may not occur. Even ascites may not accompany CSF hydrothorax in a patient without peritoneal catheter migration.

As the use of instrumentation in spinal surgery has become common, the need for revision surgery has increased. During revision surgery one of the most difficult steps is removal of poly-axial pedicle screws, especially if no suitable revision set is available. We describe here an easy method for poly-axial screw removal. Leaving or placing a small piece of rod, attached firmly by a nut, tightens the head of the poly-axial screw. It can no longer move freely from the distal part of the screw and the screw can be removed by turning it counterclockwise with a big clamp or needle driver, which is available in almost every surgery set.

No abstract