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Fulltext Post-thoracotomy paraplegia after oxidized cellulose spinal compression

Than DJ, Perumall VV, Johan S, Lee XL, Karim KA, Hayati F

Einstein (Sao Paulo), 2023;21:eRC0078.
PMID: 37436267 DOI: 10.31744/einstein_journal/2023RC0078

Post-thoracotomy paraplegia after non-aortic surgery is an extremely uncommon complication. A 56-year-old woman presented with a 1-year history of progressive shortness of breath. Computed tomography revealed a locally advanced posterior mediastinal mass involving the ribs and the left neural foramina. Tumor excision with a left pneumonectomy was performed. Post-resection, bleeding was noted in the vicinity of the T4-T5 vertebral body, and the bleeding point was packed with oxidized cellulose gauze (Surgicel®). Postoperatively, the patient complained of bilateral leg numbness extending up to the T5 level, with bilateral paraplegia. An urgent laminectomy was performed, and we noted that the spinal cord was compressed by two masses of Surgicel® with blood clots measuring 1.5 × 1.5cm at T4 and T5 levels. The paraplegia did not improve despite the removal of the mass, sufficient decompression, and aggressive postoperative physiotherapy. Surgeons operating in fields close to the intervertebral foramen should be aware of the possible threat to the adjacent spinal canal as helpful hemostatic agents can become a preventable threat.

Matched MeSH terms: Laminectomy/adverse effects; Laminectomy/methods
The Morphometric Study of Degenerative Lateral Canal Stenosis at L4-L5 and L5-S1 Using Magnetic Resonance Imaging (MRI): Feasibility Analysis for Posterior Surgical Decompression

Yusof MI, Shif M, Abdullah MS

Malays Orthop J, 2015 Mar;9(1):4-10.
PMID: 28435587 MyJurnal DOI: 10.5704/MOJ.1503.015

This study was to evaluate the morphological features of degenerative spinal stenosis and adequacy of lateral canal stenosis decompression via unilateral and bilateral laminectomy. Measurements of facet joint angulation (FJA), mid facet point (MFP), mid facet point distance (MFPD), the narrowest point of the lateral spinal canal (NPLC) and the narrowest point of the lateral spinal canal distance (NPLCD) were performed. At L4L5 of the right and left side, the mean distance between the lateral border of the dura and MFP was 1.0 ± 0.2 cm and 1.0 ± 0.3cm respectively. The mean NPLC was seen at 0.7 ± 0.3 and 0.7 ± 0.3 cm cm from the dura. At L5S1 of the right and left side, the mean distance between the lateral border of the dura and MFP was 1.2± 0.2 and 1.3 ± 0.2 cm respectively. The mean NPLC was seen at 0.8 ± 0.4 and 0.9 ± 0.5 cm from the dura. Unilateral laminectomy may result in incomplete decompression.

Matched MeSH terms: Laminectomy
Fulltext Intraspinal epidural hematoma in a warfarinized patient presenting with back pain: a case report

Jolina, W.N., Dazlin Masdiana, S., Afliza, A.B.

Medicine & Health, 2018;13(2):188-194.
MyJurnal

Warfarin is an anticoagulant that is commonly used as thrombo-prophylaxis in patients at risk of thrombo-embolic events. However, the use of warfarin is known to cause hemorrhage due to its anticoagulation effect. Although the common sites of hemorrhage are gastrointestinal and genitourinary tract, it can also occur in the least expected location. We report a rare case of spinal cord compression secondary to intraspinal epidural hematoma as a result of overwarfarinization in a patient who had undergone liver transplant. The patient underwent emergency decompression laminectomy of spinal cord and hematoma evacuation after the reversal of overwarfarinization to normal levels.

Matched MeSH terms: Laminectomy
Fulltext Hemorrhagic Thoracic Spinal Epidural Angiolipoma: A Case Report

Saufi, A., Chan, K.H., Zamzuri, Z., Ralib, A.R., Azlina, A.R.

International Medical Journal Malaysia, 2014;13(1):73-76.
MyJurnal

Spinal epidural angiolipomas are rare benign tumors. The tumors contain both vascular and mature adipose components. Typically, they present with a progressive clinical course. Acute presentation is rare. We present a case of a fifteen-year-old girl who presented with a sudden onset of backpain followed by paraparesis with bladder and bowel incontinence. Neurological examination showed sensory loss below T10 with Grade 2 motor power. Spinal MRI showed long segment extradural lesion at T6-T9 level. Multiple laminectomy and excision of the tumor containing areas of hemorrhage was performed. Histopathology report revealed angiolipoma.

Matched MeSH terms: Laminectomy
Ossified lumbar pseudomeningocele: imaging findings

Al-Edrus SA, Mohamed Mukari SA, Ganesan D, Ramli N

Spine J, 2011 Aug;11(8):796-7.
PMID: 21724472 DOI: 10.1016/j.spinee.2011.05.013
Matched MeSH terms: Laminectomy/adverse effects
Predicted cervical canal enlargement and effective cord decompression following expansive laminoplasty using cervical magnetic resonance imaging

Yusof MI, Hassan E, Abdullah S

Surg Radiol Anat, 2011 Mar;33(2):109-15.
PMID: 20658232 DOI: 10.1007/s00276-010-0704-7

Posterior translation of the spinal cord occurs passively following laminoplasty with the presence lordotic spine and availability of a space for the spinal cord to shift. This study is to predict the distance of posterior spinal cord migration after expansive laminoplasty at different cervical levels based on measurement of posterior translation of the spinal cord in normal cervical morphometry.

Matched MeSH terms: Laminectomy*
Fulltext Neurological recovery following posterior decompression of spinal secondaries

Razak M, Sappani K

Med J Malaysia, 1998 Sep;53 Suppl A:6-11.
PMID: 10968177

This is a retrospective study comprising 45 patients who underwent decompressive laminectomy due to secondary malignancy in the spine. There were 31 males and 14 females. Two of them had no weakness, one was treated for radicular pain and the other for severe intractable back pain. Forty-three patients presented with weakness of the limb of which six patients were able to walk unaided, four with an aid, twenty four were unable to walk of which eleven of them were completely paralysed. Nineteen of the patients had urinary incontinence. Out of 10 patients in Frankel's D, 3 of them regained almost normal power post operatively and were able to walk without any aids at the time of discharge. There were 6 patients in Frankel's C and 2 improved. Of 17 patients in Frankel's B, 6 of them improved and were able to walk with walking aids. Only one out of ten patient from Frankel's A had showed an improvement. A total of three patients deteriorated post operatively and all of them presented with multiple level involvement. There was no change in the post operative status of the two patients who did not have weakness. Overall only 27% of the patient showed improvement following decompressive laminectomy.

Matched MeSH terms: Laminectomy*
The Safety and Strength of a Novel Medial, Partial Nonthreaded Pedicle Screw: A Cadaveric and Biomechanical Investigation

Kwan MK, Chan CY, Saw LB, Rukmanikanthan S, Lenke LG

Clin Spine Surg, 2017 04;30(3):E297-E304.
PMID: 28323715 DOI: 10.1097/BSD.0b013e3182aab29d

STUDY DESIGN: Cadaveric and biomechanical study.
OBJECTIVE: The aim of this study was to assess the safety and pullout strength of medial, partial nonthreaded thoracic pedicle screws compared with conventional screws.
SUMMARY OF BACKGROUND DATA: The perforation rate of the pedicle screws has been reported as high as 41%. Nerve injury and irritation can result from the compression of malpositioned screw on neural structures.
METHODS: Ten fresh cadavers were studied. Screws, 5.0 and 6.0 mm, were inserted from T1 to T6 and T7 to T12, respectively. Pedicle perforations and fractures were recorded upon screw insertion and final positioning (nonthreaded portion facing medially) after a wide laminectomy. Pullout strength of novel and conventional screws were then tested using an Instron machine in an artificial bone substitute.
RESULTS: A total of 240 thoracic pedicle screws were inserted. Of them, 88.8% (213 screws) were fully contained during screw insertion. There were 5.0% (12 screws) grade 1 medial perforations and 6.2% (15 screws) grade 1 lateral perforations during screw insertion. Upon final positioning, 93.8% (225 screws) were fully contained. All grade 1 medial perforations, which occurred during insertion, were converted to grade 0. No dural or nerve root injuries occurred. Pedicle split fractures were noted in 6.7% (16 screws). The use of medial, partial nonthreaded screws reduced the overall perforation rate from 11.2% to 6.2%. The mean pullout load for the 5 mm fully threaded screw versus medial, partial nonthreaded was 1419.3±106.1 N (1275.8-1538.8 N) and 1336.6±44.2 N (1293.0-1405.1 N) respectively, whereas 6 mm pullout load averaged 2126.0±134.8 N (1986.3-2338.3 N) and 2036.5±210.0 N (1818.4-2355.9 N). The difference was not statistically significant.
CONCLUSIONS: The use of medial, partial nonthreaded pedicle screws reduced the medial perforation rate from 5.0% to 0%; however, the pullout strength was not significantly reduced. The use of this novel screw can potentially reduce the incidence of nerve injury or irritation after medial pedicle perforations.

Matched MeSH terms: Laminectomy/methods*
Fulltext Acute cauda equina syndrome secondary to free fat graft following spinal decompression

Imran Y, Halim Y

Singapore Med J, 2005 Jan;46(1):25-7.
PMID: 15633005

A 63-year-old man developed acute cauda equina syndrome due to fat graft compression. Following decompressive laminectomy and posterior instrumented fusion with pedicle screw fixation for spinal stenosis of L5 and S1 vertebral levels, free fat grafting was performed to cover the exposed dura. The patient developed gradual neurological deficit three days postoperatively. This started with sensory loss and weakness of the affected dermatomes and myotomes, followed by bowel incontinence on the 12th postoperative day. Intraoperatively, significant dural compression by the fat graft was confirmed. Immediate removal of the fat graft resulted in recovery from cauda equina syndrome.

Matched MeSH terms: Laminectomy/adverse effects*
Melioidosis presenting as spinal epidural abscess

Ganesan D, Puthucheary SD, Waran V

Br J Neurosurg, 2003 Dec;17(6):568-71.
PMID: 14756491

Central nervous system melioidosis is an unusual infection in humans. This article reports a case of melioidosis presenting as an acute spinal epidural abscess. A discussion of this case and its management together with a brief review of melioidosis of the central nervous system is presented.

Matched MeSH terms: Laminectomy
Fulltext A rare case of neurenteric cyst of spinal cord with thoracic vertebra fusion successfully managed with spinal cyst excision and posterior instrumentation surgery

Tan Jih Huei, Henry Tan Chor Lip, Chan Chee Kong, Ariz Chong B. Abdullah@Chong Chee Yong, Noor Azman Bin A. Rahman

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):348-350.
MyJurnal

The incidence of neurenteric cyst (NC) is rare amongst spine tumors. It is most often asymptomatic but may present
with sensory and motor symptoms. When associated with thoracic vertebra fusion it is not reported before, this complicates the placement of pedicle screw during posterior instrumentation. Herein, we report a case of thoracic spinal
neurenteric cyst in a 40-year-old man that presents with chronic back pain, left lower limb weakness and numbness.
Elective excision of NC over T6-T7 with laminectomy and multilevel posterior instrumentation was successfully
performed with significant improvement of the symptoms. Neurenteric cyst is a rare spinal cord lesion which may
cause permanent neurological sequalae. Complete surgical excision with spine fixation in this case provides good
long-term outcome.

Matched MeSH terms: Laminectomy
Improved spinal cord gray matter morphology induced by Spirulina platensis following spinal cord injury in rat models

Abdullahi D, Ahmad Annuar A, Sanusi J

Ultrastruct Pathol, 2020 Nov 20;44(4-6):359-371.
PMID: 32686973 DOI: 10.1080/01913123.2020.1792597

Despite intense preclinical research focusing on developing potential strategies of mitigating spinal cord injury (SCI), SCI still results in permanent, debilitating symptoms for which there are currently no effective pharmacological interventions to improve the recovery of the fine ultrastructure of the spinal cord. Spirulina platensis is thought to have potential neuroprotective effects. We have previously demonstrated its protective potential on the lesioned corticospinal tracts and behavioral recovery. In this study, spirulina, known for its neuroprotective properties was used to further explore its protective effects on spinal cord gray matter ultrastructural. Twenty-four Sprague-Dawley rats were used and divided into sham group (laminectomy without SCI), control group (SCI without S. platensis), and S. platensis group (SCI + 180 mg/kg S. platensis). All animals were anesthetized via intramuscular injection. A partial crush injury was induced at the level of T12. The rats were humanely sacrificed for 28 days postinjury for ultrastructural study. There were significant mean differences with respect to pairwise comparisons between the ultrastructural grading score of neuronal perikarya of control and the S. platensis following injury at day 28, which correlates with the functional locomotor recovery at this timepoint in our previous study. The group supplemented with spirulina, thus, revealed a better improvement in the fine ultrastructure of the spinal cord gray matter when compared to the control group thereby suggesting neuroprotective potentials of spirulina in mitigating the effects of spinal cord injury and inducing functional recovery.

Matched MeSH terms: Laminectomy
Fulltext White cord syndrome: A devastating complication of spinal decompression surgery

Vinodh VP, Rajapathy SK, Sellamuthu P, Kandasamy R

Surg Neurol Int, 2018;9:136.
PMID: 30090668 DOI: 10.4103/sni.sni_96_18

Background: Reperfusion injury of the spinal cord or "white cord syndrome" refers to the sudden onset of neurological deterioration after spinal decompressive surgery. Associated magnetic resonance (MR) findings only include focal hyperintensity on T2-weighted images without any other pathological changes.
Case Description: A patient with cervical stenosis secondary to metastatic tumor in the intradural and extradural compartments presented with lower limb paraparesis. She underwent an uneventful tumor excision accompanied by posterior cervical decompression and fusion. Postoperatively, she was quadriplegic and required ventilator support. The emergent postoperative MR scan revealed focal hyperintensity on the T2-weighted image consistent with spinal cord edema extending into the lower brain stem.
Conclusion: Very few cases of reperfusion injury of the cervical spinal cord or "white cord syndrome" are described in the literature. Here we present a patient who, following cervical laminectomy and fusion for excision of metastatic tumor, developed quadriplegia. Notably, postoperative MR showed only findings of upper cervical cord and lower brain stem edema consistent with a "white cord syndrome" without other compressive pathology.

Matched MeSH terms: Laminectomy
Fulltext Primary Ewing’s sarcoma of the lumbosacral spine: a case report

Zamzuri, Z., Mohd Adham, S.Y., Saufi, M.A., Azian, A.A., Fadhli, M.

International Medical Journal Malaysia, 2012;11(1):47-50.
MyJurnal

Ewing's sarcoma is a rare tumor first discovered by James Ewing in 1921. It is more common in bone or skeletal component compared to soft tissue or extraosseous Ewing's sarcoma. Among soft tissue Ewing’s, spinal cord involvement is rarer with only nine cases reported. We report a case of nine-year-old Malay girl who presented with low back pain for two months following a fall with progressive neurological deficits of bilateral lower limb. Magnetic resonance imaging was suggestive of a well-defined margin of intradural extramedullary tumor. With nerve sheath tumor in mind, surgical excision with laminectomy L2-S1 was performed. Intraoperative finding was an extradural mass from L3-L5 with extension to bilateral neuroforamen. Histopathology report defined a round cell tumour of Ewing’s sarcoma from the mass.

Matched MeSH terms: Laminectomy
Fulltext A Rare Case of Spinal Extradural Arachnoid Cyst with Cord Compression

Lin LC, Jason R

Asian J Neurosurg, 2018 4 24;13(2):468-470.
PMID: 29682063 DOI: 10.4103/ajns.AJNS_310_16

Spinal extradural arachnoid cysts are rare lesions which typically involve the thoracic spine and are an asymptomatic condition of unknown origin. They may also produce symptoms by compressing the spinal cord or nerve roots. Surgery is the treatment of choice in such lesions, but asymptomatic patients can be managed conservatively. We present a case of symptomatic, probable traumatic origin, spinal arachnoid cyst at our center in Hospital Kuala Lumpur, Malaysia. Magnetic resonance imaging spine showed well-defined, nonenhancing extradural cystic lesion from T5 to T6 vertebrae level compressing spinal cord anteriorly. The patient underwent T5, T6 laminoplasty, T4 partial laminectomy and excision of the cyst. Histologically, the cyst wall comprised of collagen and meningothelial cells. This surgical intervention achieved neurological improvement in terms of motor power in our follow-up of this patient.

Matched MeSH terms: Laminectomy
Fulltext Behavioral and Histopathological Study of Changes in Spinal Cord Injured Rats Supplemented with Spirulina platensis

Aziz I, Che Ramli MD, Mohd Zain NS, Sanusi J

Evid Based Complement Alternat Med, 2014;2014:871657.
PMID: 25152764 DOI: 10.1155/2014/871657

Spinal cord injury (SCI) is a devastating disease that leads to permanent disability and causes great suffering. The resulting neurological dysfunction and paralysis is proportional to the severity of the trauma itself. Spirulina is widely used as a nutritional supplement due to its high protein and antioxidant content. In the present study, the protective effect of the Spirulina treatment on locomotor function and morphological damage after SCI was investigated. Seventy Sprague-Dawley (SD) rats were divided into three groups: Sham (laminectomy alone), Control (laminectomy with SCI), and Experimental (laminectomy with SCI +180 mg/kg per day Spirulina platensis). A laminectomy was performed at T12 and an Inox No.2 modified forceps was used to perform a partial crush injury on the spinal cord. The rats were then perfused at 3, 7, 14, 21, and 28 days after injury for morphological investigations. The injured rat spinal cord indicated a presence of hemorrhage, cavity, and necrosis. Pretreatment with Spirulina significantly improved the locomotor function and showed a significant reduction on the histological changes. The experimental results observed in this study suggest that treatment with Spirulina platensis possesses potential benefits in improving hind limb locomotor function and reducing morphological damage to the spinal cord.

Matched MeSH terms: Laminectomy
Fulltext COBB syndrome treated by staged intravascular embolisation and surgery

Sayuthi S, Moret J, Pany A, Sobri A, Shafie M, Abdullah J

Med J Malaysia, 2006 Jun;61(2):239-41.
PMID: 16898321 MyJurnal

A 28-year old Malay man with evidence of an upper motor neuron cord lesion was diagnosed to have a C7 to T2 spinal arterio-venous malformation and associated cutaneous vascular lesion. He finally agreed for treatment after 5 years of progressive spastic right lower limb weakness leading to inability to mobilize. A two staged intravascular procedure was done followed by surgery with recovery of ASIA impairment scale grade B.

Matched MeSH terms: Laminectomy/methods*
Fulltext Cervical cord compression presenting with sciatica-like leg pain

Chan CK, Lee HY, Choi WC, Cho JY, Lee SH

Eur Spine J, 2011 Jul;20 Suppl 2:S217-21.
PMID: 20938789 DOI: 10.1007/s00586-010-1585-5

Sciatica-like leg pain can be the main presenting symptom in patients with cervical cord compression. It is a false localizing presentation, which may lead to missed or delayed diagnosis, resulting in the wrong plan of management, especially in the presence of concurrent lumbar lesions. Medical history, physical findings and the results of imaging studies were reviewed in two cases of cervical cord compressions, which presented with sciatica-like leg pain. There was multi-level cervical spondylosis with cord compression in the first patient and the second patient had two levels of cervical disc herniation with cord compression. In both cases, there were co-existing lumbar lesions, which could be responsible for the presentation of the leg pain. Cervical blocks were diagnostic in identifying the level responsible for the leg pain and it was confirmed so after cervical decompressive surgery in both cases, which brought significant pain relief. Funicular leg pain is a rare presentation of cervical cord compression. It is a referred pain due to the irritation of the ascending spinothalamic tract. Cervical blocks were successful in identifying the cause of funicular pain in our cases and this may pave the way for further studies to establish the role of cervical blocks as a diagnostic tool for funicular pain caused by cord compression.

Matched MeSH terms: Laminectomy
Fulltext Spontaneous Spinal Epidural Hematoma Associated With the Use of Low-dose Aspirin in Elderly Patient

Phang ZH, Chew JJ, A/P Thurairajasingam J, Ibrahim SB

J Am Acad Orthop Surg Glob Res Rev, 2018 Oct;2(10):e059.
PMID: 30656250 DOI: 10.5435/JAAOSGlobal-D-18-00059

Spontaneous spinal epidural hematoma is a rare condition defined by bleeding in the epidural space of the spine with no identifiable causes such as trauma, vascular malformation, or bleeding disorders. This is a case of a 79-year-old woman with a medical history of diabetes mellitus, dyslipidemia, and hypertension presented with the sudden onset of severe thoracolumbar back pain associated with weakness and numbness in her bilateral lower limb. Examination of the lower limb showed bilateral lower limb motor and sensory deficits. Laboratory investigations showed normal results. MRI showed posterior extradural intraspinal hematoma from T11 to L3 vertebrae. Patient underwent right hemilaminectomy and posterior decompression of T12 and L1 vertebrae to evacuate the hematoma. Postoperatively, her neurologic complications improved gradually. Decision was made not to restart aspirin. On follow-up at 1 year, the patient had complete recovery of neurologic complications of both lower limb and had no recurrence of bleeding. In short, this is a case of spontaneous spinal epidural hematoma associated with long-term use of low-dose aspirin in an elderly patient requiring surgical evacuation of hematoma with good functional outcome after the surgery. Therefore, aspirin should be prescribed cautiously especially to elderly patients.

Matched MeSH terms: Laminectomy
Fulltext Successful surgical strategy for ventral thoracic spinal perimedullary spinal arteriovenous fistulas: Case report

Subramaniam SM, Ishii K, Sheng CJ, Nakatomi H, Takai K, Saito N

Surg Neurol Int, 2019;10:251.
PMID: 31893152 DOI: 10.25259/SNI_516_2019

Background: Spinal arteriovenous fistulas (AVFs) are vascular lesions that often pose significant surgical challenges. This is particularly true for those located close to the anterior spinal artery. Here, we analyzed the surgical options for treating an anterior perimedullary AVF (pAVFs).
Case Description: A 66-year-old male with the right lower extremity weakness was diagnosed with a spinal dural AVF at the L1 level. It was initially treated with open surgery followed by CyberKnife radiosurgery at another institution. Five years later, he presented with a persistent pAVF fistula now involving the T11 level; the major feeder originated on the left at the T7-T8 level (e.g., involving a left-sided "duplicated" anterior spinal artery). Utilizing a three-dimensional (3D) computer tomography (CT) guided approach; he underwent a left-sided posterolateral T10-T12 laminectomy, sufficient to allow for 30-40° of anterior spinal cord rotation. This was performed under neurophysiological monitoring without any significant changes. Surgery included indocyanine green video angiography, temporary feeder clipping, and complete occlusion of the AVF, followed by complete clipping/resection as confirmed on postoperative magnetic resonance imaging.
Conclusion: Utilizing a 3D CT image, a ventral pulmonary arteriovenous malformation was excised utilizing a left-sided posterolateral approach allowing for 30-40° of cord rotation.

Matched MeSH terms: Laminectomy

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