MRI Changes of the Spinal Subdural Space after Lumbar Spine Surgeries: Report of Two Cases

Abstract

Although magnetic resonance imaging (MRI) is frequently used to assess the lumbar spine, there are few reports in the medical literature that have evaluated using MRI immediately following spinal surgery. Furthermore, descriptions of the subdural changes after lumbar spine surgery are also infrequent. In this paper, we present two cases with subdural change seen on MRI immediately after lumbar surgery. Both the patients had mild symptoms that resolved spontaneously, and the follow-up MRI scans showed resolution of the subdural changes. Subdural changes should be considered as one of the possible causes of unexpected symptoms in patients following lumbar spinal surgery.

Thoracic spinal subdural hematoma complicating anterior cervical discectomy and fusion: case report

“…Lastly, in 1993, Reinsel and colleagues described the formation of a subdural hematoma and credited its formation to trauma during preoperative myelopathy. 11 In all previous reports of subdural hematoma formation following spinal surgery, the surgical location and formation of the subdural hematoma were in close proximity, 5,6,13 presumably suggesting intraoperative trauma to the dural tissue. In the present case, however, the subdural hematoma formed in the thoracic spine following a cervical discectomy and fusion, which is suggestive of a different etiology and/or pathomechanism.…”

“…5 In 2011, Sakai et al described 2 cases of subdural hematoma formation following lumbar surgery. 13 Neither patient had intraoperative dural complications or postoperative evidence of cerebrospinal fluid in the drain tubes. In both cases, the symptoms were mild and gradually improved without surgical intervention.…”

“…The authors presumed that the subdural or intradural vessels were compromised during the surgical procedure with resultant hematoma formation. 13 In the case described by Gehri et al a spinal subdural hematoma formed following a microdiscectomy and unintended durotomy. 6 Despite repair, a subdural hematoma subsequently formed at the durotomy site, requiring surgical evacuation.…”

“…To the best of our knowledge, only 4 reports have described subdural hematoma formation following spinal surgery. 5,6,11,13 In all reports, hematoma formation was attributed to trauma.…”

“…1,3,4,7,8,10,12,14 Throughout the literature, few reports have described the occurrence of a spinal subdural hematoma following spinal surgery. 5,6,13 To our knowledge, no study has detailed the onset of a spinal subdural hematoma at the thoracic level following surgery on the cervical spine. The present report describes a case in which a patient underwent an anterior cervical discectomy and fusion of C5-6 and postoperatively developed a thoracic subdural hematoma.…”