Although spinal arachnoid cysts are relatively common findings observed incidentally in adults, they are much rarely reported in children. They are usually asymptomatic and are mainly located in the middle and lower thoracic regions. However, in rare circumstances, these cysts can cause mass effects that lead to neurologic symptoms. We report the rare case of a spinal extradural arachnoid cyst in a 12-year-old boy who showed signs and symptoms of cauda equina syndrome. Magnetic resonance imaging of the lumbar spine revealed a huge extradural arachnoid cyst extending from L2 to L5. Emergent laminectomy and repair of dural defect was performed after total resection of the extradural arachnoid cyst. There were no postoperative complications. Total recovery was achieved 6 months after surgery. Here, we report this rare case with a review of the literature.
Posterior screwing with interbody fusion is commonly performed for the treatment of many different spine pathologies. Despite immediate and strong fixation, as well as a relatively few device-related complications, screw fixation for the purpose of bone fusion in the soteopenic or osteoporotic spine still remains a challenge [1,2]. A typical complication of pedicle screw fixation is screw loosening and the estimated rate ranges from 0.8% to 27%, and the incidence rate increases rapidly in cases of severe osteoporotic spine [3,4].In cases of symptomatic pedicle screw loosening unfortunately, few treatment options exist. The typical treatment is extensive Objective: The aim of this study was to evaluate the feasibility and safety of screw reimplantation via a different trajectory as a minimally invasive alternative to extensive open surgery for symptomatic low-grade screw loosening. Methods: Among patients who underwent single-level posterior lumbar interbody fusion and percutaneous screw fixation, a consecutive series of 10 patients in whom percutaneous screw reimplantation was performed via a different trajectory due to pedicle screw loosening were included in this study. Pedicle screw loosening was deemed clinically relevant in cases of continuous back pain with radiolucent halo zones at a vertebral level. All patients were treated via a posterior approach with removal of the loosened screws and augmentation of the allograft bone chips, followed by reimplantation with a different downward and medial trajectory using a larger-diameter screw. Demographic, preoperative, and postoperative data were collected and analyzed. Results: The loosened screws could be removed without difficulty, and reimplantation was successfully performed via a new trajectory with larger screws in all patients. All patients reported significant pain relief at the final follow-up. Moreover, no severe complications, such as wound infection or repeated screw loosening, were observed during the follow-up period. Conclusion: Percutaneous reimplantation of screws via a different trajectory for pedicle screw loosening with larger screws can be safely attempted in selected patients to relieve pain and avoid extensive long-level screw fixation.
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