Ortega ZJM, Riqué DJ, Sánchez GR, Calvo AM, Lomillos PN

Language: Spanish
References: 11
Page: 34-39
PDF size: 393.05 Kb.

ABSTRACT

Introduction: Postoperative pseudomeningocele secondary to cervical laminectomy is often asymptomatic and resolves spontaneously. Rarely, progressive symptoms develop, from pain, either local or radicular, until loss of muscle strength due to spinal cord compression.
Clinical case: Male patient, 72 years old with bilateral pain in the neck and brachialgia. Also he refers progressive gait difficult with occasionally stick need and frequent falls. Neurological examination showed spastic tetraparesis. MRI showed degenerative changes from C3 to C7, degenerative disc disease, disc prolapses and osteophyte formation. Cervical laminectomy was performed after the diagnosis of cervical spondylosis and decompensated myelopathy with multisegmental involvement (Nurick grade 4). He was discharged 10 days after surgery without complications, and walking independently. Postoperatively, the patient suffered clinical worsening leading to quadriplegia, and cervical pseudomeningocele with cord compression was diagnosed by MRI later. Lumbar puncture and lumboperitoneal shunt were ineffective, probably due to the establishment of a valve system in the surgical area. Cervical pseudomeningocele dimensions decreased with dural repair and surgical cystoperitoneal bypass, but tetraparesis persist.
Conclusions: Cervical pseudomeningocele must be considered as a cause of tetraparesis after posterior cervical spine surgery and its importance must not be underestimated. Early treatment of pseudomeningocele is essential for the recovery of neurological defect.

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