Spinal Hernia Repair and Cauda Equina Repositioning after Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review.

IF 1.2 4区 综合性期刊 Q3 MULTIDISCIPLINARY SCIENCES Jove-Journal of Visualized Experiments Pub Date : 2024-11-08 DOI:10.3791/67045
Zhenhao Zhang, YiBo Dong, YiZhou Xie, HanXiang Yang, Xiaohong Fan, Yang Yu
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Abstract

Cauda equina herniation (CEH) is a relatively rare and severe perioperative complication that may occur after lumbar spine surgery. Here, we present a case report of a 36-year-old female patient who experienced CEH after an endoscopic L5-S1 laminectomy and discectomy. The patient presented with right L5-S1 radiculopathy that correlated with findings in medical imaging and physical examination. Subsequently, she underwent endoscopic L5-S1 laminotomy and discectomy. A day after the operation, the patient developed urine leakage, hematochezia, aggravated constipation, and found no relief from pain in the right lower limb. MRI revealed cerebrospinal fluid leakage at the surgical site. After consultation with the urology and anorectal department, the patient was fitted with a urinary catheter, prescribed hemorrhoid medication, and underwent anal sphincter training as recommended by the doctor. After 1 week of treatment, the patient's urinary function returned to normal, but constipation persisted while the pain in the right lower limb eased. After 5 months, the patient was hospitalized due to radiating pain in both lower limbs and constipation. An MRI revealed herniation of the L5/S1 nerve root sac. Subsequently, L5/S1 total laminectomy decompression and dural sac repair were performed under a three-dimensional (3D) microscopy. Postoperatively, lower limb pain and constipation were alleviated. CEH following spinal endoscopy, though rare, demands significant clinical attention. The successful outcome in this case illustrates the value of surgical revision under 3D microscopic guidance, offering a viable strategy for patients presenting with this complication.

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三维显微镜下腰椎减压术后的脊柱疝修补和马尾复位:病例报告和文献综述。
马尾疝(CEH)是腰椎手术后可能出现的一种相对罕见且严重的围手术期并发症。我们在此报告了一例 36 岁女性患者的病例,她在接受内窥镜下 L5-S1 椎板切除术和椎间盘切除术后出现了马尾疝。患者出现右侧 L5-S1 根性病变,与医学影像和体格检查结果相关。随后,她接受了内窥镜下 L5-S1 椎板切除术和椎间盘切除术。术后一天,患者出现漏尿、血尿、便秘加重,右下肢疼痛无缓解。核磁共振成像显示手术部位有脑脊液渗漏。泌尿科和肛肠科会诊后,为患者安装了导尿管,开了痔疮药,并按照医生的建议进行了肛门括约肌训练。治疗一周后,患者的排尿功能恢复正常,但便秘仍然存在,右下肢疼痛有所缓解。5 个月后,患者因双下肢放射痛和便秘而住院治疗。核磁共振检查显示,L5/S1 神经根囊疝出。随后,在三维(3D)显微镜下进行了 L5/S1 全椎板切除减压术和硬膜囊修复术。术后,下肢疼痛和便秘得到缓解。脊柱内窥镜手术后出现 CEH 的情况虽然罕见,但需要引起临床高度重视。本病例的成功结果说明了在三维显微镜引导下进行手术修补的价值,为出现这种并发症的患者提供了一种可行的策略。
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来源期刊
Jove-Journal of Visualized Experiments
Jove-Journal of Visualized Experiments MULTIDISCIPLINARY SCIENCES-
CiteScore
2.10
自引率
0.00%
发文量
992
期刊介绍: JoVE, the Journal of Visualized Experiments, is the world''s first peer reviewed scientific video journal. Established in 2006, JoVE is devoted to publishing scientific research in a visual format to help researchers overcome two of the biggest challenges facing the scientific research community today; poor reproducibility and the time and labor intensive nature of learning new experimental techniques.
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