Epidural air entrapment after spinal surgery

Kaymaz, Memduh; Öztanir, Namık; Emmez, Hakan; Paşaoğlu, Aydın

doi:10.1016/j.clineuro.2004.09.016

Cited by 10 publications

(14 citation statements)

References 8 publications

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“…Based on the current case and those previously reported, we think that conservative management should always be attempted first, when clinical signs of EG appear after lumbar surgery. As noted, postoperative EG may resolve spontaneously with time 9 , 10) . But, if the patient does not improve with conservative treatment, more invasive procedure, including the needle aspiration, or surgery, is needed.…”

Section: Discussionmentioning

confidence: 70%

“…Other authors suggested that the treatment needs to be targeted to the disc, as well as the gaseous cyst, and recommended ensuring adequate foraminotomy, carefully removing the membranous soft tissue near the nerve root during the operation in order to prevent reaccumulation or persistence of air in the lumbar epidural space 16 , 20) . Irrigating the surgical field well with isotonic saline and longer stay of the drain, postoperatively, during the revision surgery was also mentioned as surgical tips 10) . The ABR and immobilization with brace to restrict the motion in pathologic segments are also advisable, in order to lower the chances of radicular compression by the re-accumulation of the air.…”

Section: Discussionmentioning

confidence: 99%

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Radicular Compression by Intraspinal Epidural Gas Bubble Occurred in Distant Two Levels after Lumbar Microdiscectomy

Lee¹,

Yoon²,

Ha³

et al. 2014

J Korean Neurosurg Soc

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The authors report a case of symptomatic epidural gas accumulation 2 weeks after the multi-level lumbar surgery, causing postoperative recurrent radiculopathy. The accumulation of epidural gas compressing the dural sac and nerve root was demonstrated by CT and MRI at the distant two levels, L3-4 and L5-S1, where vacuum in disc space was observed preoperatively and both laminectomy and discectomy had been done. However, postoperative air was not identified at L4-5 level where only laminectomy had been done in same surgical field, which suggested the relationship between postoperative epidural gas and the manipulation of disc structure. Conservative treatment and needle aspiration was performed, but not effective to relieve patient's symptoms. The patient underwent revision surgery to remove the gaseous cyst. Her leg pain was improved after the second operation.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Radicular Compression by Intraspinal Epidural Gas Bubble Occurred in Distant Two Levels after Lumbar Microdiscectomy

Lee¹,

Yoon²,

Ha³

et al. 2014

J Korean Neurosurg Soc

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“…Symptomatic EG after lumbar MD has been reported a few times. 3 9 12 13 17 18) All previously reported EG formation associated with recurrent symptoms were found in the ventral epidural space. Kaymaz et al 12) reported symptomatic EG located in the ventromedial and dorsal epidural space after MD, but the dorsal EG in this case did not compress the dural sac.…”

Section: Discussionmentioning

confidence: 97%

“… 3 9 12 13 17 18) All previously reported EG formation associated with recurrent symptoms were found in the ventral epidural space. Kaymaz et al 12) reported symptomatic EG located in the ventromedial and dorsal epidural space after MD, but the dorsal EG in this case did not compress the dural sac. Considering anatomical distances from the annulus, it is no wonder that the probability of ventral EG formation after lumbar MD is higher than that of dorsal EG formation because the ventral epidural space is closer to the annulus than the dorsal epidural space.…”

Section: Discussionmentioning

confidence: 97%

“…It could be observed in association with degenerative disc disease, spinal tumors, spinal infection, spinal trauma, and iatrogenic processes. 1 3 11 12 13 15 16 17 18 19 20) Gas liberation from the intervertebral disc to epidural space is relatively common. Although EG formation is usually asymptomatic, there have been several reports of symptomatic EG causing severe back pain or radiculopathy.…”

Section: Introductionmentioning

confidence: 99%

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Dorsal Epidural Gas after Lumbar Microdiskectomy Treated with CT-guided Needle Aspiration

Bang

Lee

et al. 2020

Korean J Neurotrauma

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To present a case of unusual dorsal epidural gas (EG) accumulation after a simple lumbar microdiskectomy (MD), treated with computed tomography (CT)-guided needle aspiration. A 78-year-old woman underwent simple lumbar MD at the L3–4 level. One week after the operation, the patient complained of severe back pain radiating to the right thigh. Follow-up magnetic resonance imaging (MRI) and CT revealed huge EG formation at the dorsal L3–4 epidural space. Conservative treatment did not resolve the patient's pain. We performed CT-guided needle aspiration after 1 week of conservative treatment. The patient's pain fully resolved after aspiration, but it recurred 1 week later. Follow-up MRI and CT revealed re-accumulation of the dorsal EG at the L3–4 level. CT-guided needle aspiration was repeated, again leading to full pain resolution. Follow-up CT 6 months after the second aspiration showed no recurrent dorsal EG. The patient has been symptom-free for 1 year since the second aspiration. CT-guided needle aspiration is a safe and effective alternative to re-operation in the context of dorsal EG formation after MD.

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Successful conservative management of epidural gas accumulation and haematoma formation following a lateral corpectomy in a dog

Madden

Atkins

Khan

et al. 2022

Vet Record Case Reports

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A 9‐year‐8‐month‐old, male, neutered labrador crossbreed dog was presented for evaluation of a chronic, progressive pelvic limb ataxia and thoracolumbar hyperaesthesia. The patient was diagnosed with a T12–T13 intervertebral disc protrusion and treated surgically with a lateral corpectomy procedure. After an initial post‐operative improvement, the dog acutely deteriorated to the point of severe non‐ambulatory paraparesis, with recurrence of thoracolumbar hyperaesthesia. A computed tomography scan revealed the presence of epidural gas accumulation and haematoma at the corpectomy site, causing moderate spinal cord compression. The patient was treated conservatively with strict rest and analgesia with subsequent neurological improvement. At the recheck appointment 6 weeks after surgery, the dog had demonstrated improvement from its pre‐surgical neurological status.

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Epidural air entrapment after spinal surgery

Cited by 10 publications

References 8 publications

Radicular Compression by Intraspinal Epidural Gas Bubble Occurred in Distant Two Levels after Lumbar Microdiscectomy

Radicular Compression by Intraspinal Epidural Gas Bubble Occurred in Distant Two Levels after Lumbar Microdiscectomy

Dorsal Epidural Gas after Lumbar Microdiskectomy Treated with CT-guided Needle Aspiration

Successful conservative management of epidural gas accumulation and haematoma formation following a lateral corpectomy in a dog

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