Delayed neurological dysfunction following posterior laminectomy with lateral mass screw fixation:A case report and review of literature  

作　　者：Rui-Zhong Yan Chao Chen Chu-Ran Lin Yan-Hui Wei Zhi-Jian Guo Ya-Kun Li Quan Zhang He-Yi Shen Hao-Lin Sun 

机构地区：[1]Department of Orthopedics,Taiyuan Central Hospital,Taiyuan 030009,Shanxi Province,China [2]Department of Orthopedics,Graduate School Shanxi University of Traditional Chinese Medicine,Taiyuan 030024,Shanxi Province,China [3]Department of Orthopedics,Peking University First Hospital,Beijing 100034,China

出　　处：《World Journal of Clinical Cases》2024年第7期1356-1364,共9页世界临床病例杂志

摘　　要：BACKGROUND While most complications of cervical surgery are reversible,some,such as symptomatic postoperative spinal epidural hematoma(SEH),which generally occurs within 24 h,are associated with increased morbidity and mortality.Delayed neurological dysfunction is diagnosed in cases when symptoms present>3 d postoperatively.Owing to its rarity,the risk factors for delayed neurological dysfunction are unclear.Consequently,this condition can result in irreversible neurological deficits and serious consequences.In this paper,we present a case of postoperative SEH that developed three days after hematoma evacuation.CASE SUMMARY A 68-year-old man with an American Spinal Injury Association(ASIA)grade C injury was admitted to our hospital with neck pain and tetraplegia following a fall.The C3-C7 posterior laminectomy and the lateral mass screw fixation surgery were performed on the tenth day.Postoperatively,the patient showed no changes in muscle strength or ASIA grade.The patient experienced neck pain and subcutaneous swelling on the third day postoperatively,his muscle strength decreased,and his ASIA score was grade A.Magnetic resonance imaging showed hypointense signals on T1 weighted image(T1WI)and T2WI located behind the epidural space,with spinal cord compression.Emergency surgical intervention for the hematoma was performed 12 h after onset.Although hypoproteinemia and pleural effusion did not improve in the perioperative period,the patient recovered to ASIA grade C on day 30 after surgery,and was transferred to a functional rehabilitation exercise unit.CONCLUSION This case shows that amelioration of low blood albumin and pleural effusion is an important aspect of the perioperative management of cervical surgery.Surgery to relieve the pressure on the spinal cord should be performed as soon as possible to decrease neurological disabilities.

关 键 词：Delayed postoperative spinal epidural hematoma Complications Spinal surgery HYPOPROTEINEMIA Risk factor Case report 

分 类 号：R735.35[医药卫生—肿瘤]