Cervical pseudomeningocele as a cause of neurological decline after posterior cervical spine surgery

Morgan, Steven; Krishna, Vibhor; Varma, Abhay K.

doi:10.4103/0028-3886.96434

Cited by 6 publications

(13 citation statements)

References 8 publications

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“…Direct compression of the spinal cord by an enlarging PMC tends to occur early, 6,9,21 whereas delayed myelopathy results from herniation of neural tissue through a dural defect, often several months to years later. 4,5,8,9,11,12 The latter may result from chronic ischemia of an incarcerated spinal cord. 9 The majority of these cases were treated with surgical exploration, reduction of the herniated nervous tissue, and direct repair of the dural defect.…”

Section: Discussionmentioning

confidence: 99%

Rare Complications of Cervical Spine Surgery: Pseudomeningocoele

Ailon

Smith

Nassr

et al. 2017

Global Spine Journal

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Study Design:This study was a retrospective, multicenter cohort study.Objectives:Rare complications of cervical spine surgery are inherently difficult to investigate. Pseudomeningocoele (PMC), an abnormal collection of cerebrospinal fluid that communicates with the subarachnoid space, is one such complication. In order to evaluate and better understand the incidence, presentation, treatment, and outcome of PMC following cervical spine surgery, we conducted a multicenter study to pool our collective experience.Methods:This study was a retrospective, multicenter cohort study of patients who underwent cervical spine surgery at any level(s) from C2 to C7, inclusive; were over 18 years of age; and experienced a postoperative PMC.Results:Thirteen patients (0.08%) developed a postoperative PMC, 6 (46.2%) of whom were female. They had an average age of 48.2 years and stayed in hospital a mean of 11.2 days. Three patients were current smokers, 3 previous smokers, 5 had never smoked, and 2 had unknown smoking status. The majority, 10 (76.9%), were associated with posterior surgery, whereas 3 (23.1%) occurred after an anterior procedure. Myelopathy was the most common indication for operations that were complicated by PMC (46%). Seven patients (53%) required a surgical procedure to address the PMC, whereas the remaining 6 were treated conservatively. All PMCs ultimately resolved or were successfully treated with no residual effects.Conclusions:PMC is a rare complication of cervical surgery with an incidence of less than 0.1%. They prolong hospital stay. PMCs occurred more frequently in association with posterior approaches. Approximately half of PMCs required surgery and all ultimately resolved without residual neurologic or other long-term effects.

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Section: Discussionmentioning

confidence: 99%

Rare Complications of Cervical Spine Surgery: Pseudomeningocoele

Ailon

Smith

Nassr

et al. 2017

Global Spine Journal

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“…To our knowledge, few studies have reported major neurologic deficits caused by a pseudomeningocele following spine surgery. 14–19 …”

Section: Discussionmentioning

confidence: 99%

“…2,13 Major postoperative neurologic deficits caused by compressive pseudomeningocele lesions following spine surgery have not been well described in the literature. 14–19 The purpose of this article is to describe the rare occurrence of this potentially catastrophic postoperative complication and to raise the level of awareness among practicing spinal surgeons.…”

Section: Introductionmentioning

confidence: 99%

Large Compressive Pseudomeningocele Causing Early Major Neurologic Deficit After Spinal Surgery

Raudenbush

Molinari

2017

Global Spine Journal

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Study Design:Retrospective review.Objectives:Large compressive pseudomeningocele causing a major neurologic deficit is a very rare complication that is not well described in the existing literature.Methods:Institutional review board consent was obtained to study 2552 consecutive extradural spinal surgical cases performed by a single senior spinal surgeon during a 10-year period. The surgeon’s database for the decade was retrospectively reviewed and 3 cases involving postoperative major neurologic deficits caused by large compressive pseudomeningocele were identified.Results:The incidence of postoperative compressive pseudomeningocele causing major neurologic deficit was 0.12% (3/2552) per decade of spinal surgery with approximately 1.3% of cases incurring incidental durotomy. Average age of the patients was 57 years (range 45-78). One patient had posterior cervical spine surgery, and 2 patients had posterior lumbar surgery. All 3 patients had intraoperative incidental durotomy repaired during their index procedure. Large compressive pseudomeningocele causing major neurologic deficit occurred in the early 2-week postoperative period in all patients and was clearly identified on postoperative magnetic resonance imaging. All 3 patients were treated with emergent decompression and repair of the dural defect. All patients recovered neurologic function after revision surgery.Conclusions:Incidental durotomy and repair causing a large compressive pseudomeningocele after spine surgery is a rare and potentially devastating event. Early postoperative magnetic resonance imaging assists in the diagnosis. Emergent decompression combined with revision dural repair surgery may result in improved outcomes. Surgeons should be cognizant of this rare cause of early postoperative major neurologic deficit in patients who had previous dural repair.

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“…The cyst and its connection with intrathecal subarachnoid space might be seen. 9,10,15 Once formation of a pseudomeningocele is confirmed a therapeutic decision making is necessary. However, optimal management is dependent on many factors, including sac size, location, clinical picture and the time of diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Cervical pseudomeningoceles are mostly located posteriorly and develop as the result of dural tear during laminectomy. [4][5][6][7][8][9][10] But, in rare occasions, iatrogenic cervical pseudomeningoceles may occur after anterior cervical procedures mainly after ACCF rather than ACDF as a consequence of an inadvertent tear of the dura mater and pia arachnoid breach or a lack of closure of the dural tear with resultant CSF leakage into the anterior compartment of the neck. [11][12][13][14][15][16][17] A chronic case which is the consequence of microdural tear, a pseudomeningocele develops from a month and later after surgery where time permits the surrounding tissue to react with formation of fibrous capsule around the CSF collection.…”

Section: Introductionmentioning

confidence: 99%

Remote Cervical Pseudomeningocele Following Anterior Cervical Corpectomy and Fusion: Report of a Case and Review of the Literature

Rahimizadeh¹,

Soufiani²,

Rahimizadeh

2016

Int J Spine Surg

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Iatrogenic cervical pseudomeningocele is a rare event and majority are located posteriorly as a delayed complication of inadvertent dural tear after decompressive laminectomy. However, iatrogenic anterior cervical pseudomeningocele subsequent to discectomy or corpectomy is a rare pathology. The time necessary for formation of pseudomeningocele varies and depend on the width of the dural tear and the flow of cerebrospinal fluid leakage. Large tears with high CSF flow usually result in early collection of the cerebrospinal fluid in anterior compartment of the neck designated acute pseudomeningoceles. Micro-tears of dura mater, with low flow of cerebrospinal fluid may lead to late formation of a pseudomeningocele known as chronic ones.Herein a 49-year-old woman in whom cervical pseudomeningocele appeared clinically as a mass on the anterior aspect of the neck, six months after anterior cervical corpectomy for cervical spondylotic myelopathy is presented. Otherwise, she was neurologically stable. Cystoperitoneal shunt was proposed which she refused. Surprisingly, at 2-year follow-up, the cyst had remained of the same size. To the best of our knowledge, this is the first example of post-operative chronic cervical pseudomeningocele in the literature, the event that might propose the self-limited natural course of this rare pathology in chronic cases.keywords: anterior cervical discectomy fusion (acdf), anterior cervical corpectomy fusion (accf), cervical pseudomeningocele, complication, cystoperitoneal shunt volume 10 article 36

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Cervical pseudomeningocele as a cause of neurological decline after posterior cervical spine surgery

Cited by 6 publications

References 8 publications

Rare Complications of Cervical Spine Surgery: Pseudomeningocoele

Rare Complications of Cervical Spine Surgery: Pseudomeningocoele

Large Compressive Pseudomeningocele Causing Early Major Neurologic Deficit After Spinal Surgery

Remote Cervical Pseudomeningocele Following Anterior Cervical Corpectomy and Fusion: Report of a Case and Review of the Literature

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