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Dynamic paraspinal muscle impingement inflicting acute hemiplegia after C1 posterior arch laminectomy: A case report.
Medication (Baltimore). 2017 Dec;96(50):e9264
Authors: Notani N, Miyazaki M, Yoshiiwa T, Ishihara T, Kanezaki S, Tsumura H
Summary
RATIONALE: Acute neurological deficits following spinal surgical procedure generally outcome from epidural hematoma, surgical trauma, vascular compromise, and graft or impingement, with the trigger recognized by magnetic resonance imaging (MRI). We current a uncommon case of dynamic paraspinal muscle impingement after C1 posterior arch laminectomy, which was recognized by myelography, with no important findings on MRI.
PATIENT CONCERNS: An 81-year-old, severely overweight male, was referred to our division for the therapy of vertebral illness of the lumbar backbone. The affected person offered with bilateral weak point and numbness of the higher extremities and gait disturbances. Based mostly on MRI, a prognosis of retro-odontoid pseudotumor was made, and C1 posterior arch laminectomy, together with C4 partial laminectomy and C5 to C6 laminoplasty, was carried out. On postoperative day three, the affected person’s neurological standing deteriorated, with proper higher extremity and proper decrease extremity weak point rising with neck extension. Though there was no proof of epidural hematoma formation on MRI, obstruction of the circulation of distinction medium by an exterior posterior compression in neck extension on the degree of C1 was recognized by myelography. Revision surgical procedure was carried out and native muscle swelling on the surgical website recognized with no hematoma formation. Occiput to C3 fixation, with instrumentation, was carried out.
OUTCOMES: Muscle energy of the fitting higher extremity and decrease extremities recovered postsurgery, and the affected person has continued to enhance operate three years after surgical procedure, with no additional neurological episodes.
LESSONS: Dynamic paraspinal muscle impingement following C1 laminectomy in a muscular man was recognized by myelography, with no important findings on normal MRI.
CONCLUSION: The potential for dynamic paraspinal muscle impingement must be thought of in sufferers creating acute, progressive, neurological deficits after posterior cervical decompression, with myelography being the imaging technique of selection for prognosis.
PMID: 29390372 [PubMed – in process]