Management of giant pseudomeningoceles after spinal surgery

<p>Abstract</p> <p>Background</p> <p>Pseudomeningoceles are a rare complication after spinal surgery, and studies on these complex formations are few.</p> <p>Methods</p> <p>Between October 2000 and March 2008, 11 patients who developed symptomatic pseudomeningoceles after spinal surgery were recruited. In this retrospective study, we reported our experiences in the management of these complex, symptomatic pseudomeningoceles after spinal surgery. A giant pseudomeningocele was defined as a pseudomeningocele >8 cm in length. We also evaluated the risk factors for the formation of giant pseudomeningoceles.</p> <p>Results</p> <p>All patients were treated successfully with a combined treatment protocol of open revision surgery for extirpation of the pseudomeningoceles, repair of dural tears, and implantation of a subarachnoid catheter for drainage. Surgery-related complications were not observed. Recurrence of pseudomeningocele was not observed for any patient at a mean follow-up of 16.5 months. This result was confirmed by magnetic resonance imaging.</p> <p>Conclusions</p> <p>We conclude that a combined treatment protocol involving open revision surgery for extirpation of pseudomeningoceles, repair of dural tears, and implantation of a subarachnoid catheter for drainage is safe and effective to treat giant pseudomeningoceles.</p

Man-in-the-barrel syndrome after thoracoilium fusion

The authors report a case of man-in-the-barrel (MIB) syndrome occurring after an extensive revision involving thoracoilium instrumentation and fusion for iatrogenic and degenerative scoliosis, progressive kyphosis, and sagittal imbalance. Isolated brachial diplegia is a rare neurological finding often attributed to cerebral ischemia. It has not been previously reported in patients Undergoing complex spine Surgery, This 70-year-old woman, who had previously undergone T11-S1 fusion for lumbar stenosis and scoliosis, presented with increased difficulty walking and with back pain. She had junctional kyphosis and L5-S1 pseudarthrosis and required revision fusion extending from T-3 to the ilium. In the early postoperative period, she experienced a 30-minute episode of substantial hypotension. She developed delirium and isolated brachial diplegia. consistent with MIB syndrome. Multiple Studies were performed to assess the origin of this brachial diplegia. There wits no definitive radiological evidence of any causative lesion. After a few days, her cognitive function returned to normal and she regained the ability to move her arms. After several weeks of rehabilitation. she recovered completely. Man-in-the-barrel syndrome is a rare neurologgical entity. It can result from various mechanisms but most commonly seems to be related to ischemia and is potentially reversible. (DOI: 10.3171/SPI.2008.8.08485)9656656

Prevalence and risk factors for unplanned return to oroom for complex adult spinal deformity patients: scoli-risk 1 prospective multicenter international study

Podium Presentation Abstracts: Paper no. 59SUMMARY: This is a prospective, multicentre international study of 272 subjects undergoing complex adult spine deformity (ASD) surgery with 2 year follow-up. The prevalence of unplanned return to operating room (OR) was 22% overall, with 4% within 30 days of index surgery. Risk factors included a more severe neurological deficit, older age, smokers, diabetes, hypertension, and osteoporosis. HYPOTHESIS: The prevalence of unplanned return to OR after ASD surgery is high. DESIGN: A prospective, multicentre international study. INTRODUCTION: A high-risk of complications had been noted in complex ASD surgery. This study reports the prevalence and risk factors of unplanned return to OR in ASD patients who underwent surgical treatment. METHODS: ASD patients who underwent surgical treatment were enrolled prospectively as part of the Scolirisk 1 study and followed for 2 years. Clinical profiles and complications were recorded preoperatively and throughout the follow-up period. RESULTS: 272 ASD patients were assessed. A total of 86 unplanned additional spine surgeries were performed on 60 subjects(22%). Eleven additional surgeries were performed within 30 days of the indexed surgery, 6 of which were due to wound infections, and one each of dural tear, CSF leak, inadequate correction, implant failure, graft dislodgement. For those returned to the operating room after 30 days from the indexed surgery (75), causes included implant failure(46%), wound infections (22%), loss of correction(16%), pseudarthrosis(15%), proximal junctional kyphosis(7%), adjacent segment problems(8%), screw loosening(5%), screw malposition(5%), prominent implants(3%), and vertebral fracture(3%). Preexisting risk factors that predicted one or more unplanned return to surgery included a more severe neurological deficit (p=0.01), older age (p=0.05), smokers (p=0.03), diabetes (p=0.05), hypertension (p=0.04), and osteoporosis (p=0.02). CONCLUSION: There is a high rate of unplanned return to OR after complex ASD surgery. Risk factors were determined and maybe useful for preoperative counselling of patients undergoing such surgeries, as well as clinical decision making