Transient Paraparesis After Laminectomy in a Patient with Multi-Level Ossification of the Spinal Ligament

Abstract

Acute neurologic deterioration is not a rare event in the surgical decompression for thoracic spinal stenosis. We report a case of transient paraparesis after decompressive laminectomy in a 50-yr-old male patient with multi-level thoracic ossification of the ligamentum flavum and cervical ossification of the posterior longitudinal ligament. Decompressive laminectomy from T9 to T11 was performed without gross neurological improvement. Two weeks after the first operation, laminoplasty from C4 to C6 and additional decompressive laminectomies of T3, T4, T6, and T8 were performed. Paraparesis developed 3 hr after the second operation, which recovered spontaneously 5 hr thereafter. CT and MRI were immediately performed, but there were no corresponding lesions. Vascular compromise of the borderlines of the arterial supply by microthrombi might be responsible for the paraparesis.

Delayed neurological deterioration with an unknown cause subsequent to surgery for intraspinal meningiomas

“…There are several theories for neurological deterioration subsequent to cord decompression, and iatrogenic cord insult is a well-known possible etiology (11,12). However, the timing, nature and underlying circumstances of the neurological deficits observed in the present patients suggests that alternative underlying mechanisms more likely than direct cord trauma (4)(5)(6)8). Post-operative hematomas may be a cause of neurological deterioration (13), but the patients are able to move all extremities following the surgical procedure (5,(14)(15)(16)(17)(18).…”

“…However, careful surgical techniques and intraoperative neuromonitoring can indicate any potential trauma to neural tissue during the tumor removal and decompression procedures (1,4,5). In the absence of clear etiology, vascular insult and toxic mechanisms may be responsible for the neurological deterioration (4,5).…”

“…With the development of modern neuroradiological techniques and standard microneurosurgical procedures, intraspinal meningiomas can be removed with low morbidity and a good outcome (1). However, the development of a delayed neurological deficit in the post-operative period occurs often in patients with chronic compressive spinal cord lesions, including cervical spondylotic myelopathy, ossification of the spinal ligament and spinal stenosis (4)(5)(6)(7)(8), and can be identified in a small subset of patients with intraspinal meningiomas. Neurological deterioration or even paralysis subsequent to surgery is extremely rare, but these are the most serious complications (5)(6)(7).…”

Transient neurological deficit following midthoracic decompression for severe stenosis: a series of three cases

“…However, a potential mechanism for decompression-related reperfusion injury of chronic ischemia (stenosis) has to date not been established. Microthrombi compromising the watershed regions of arterial supply are another possible etiology of transient postoperative paralysis after thoracic decompression surgery [8]. Compromise of the watershed region of the spine deserves special consideration in the presented cases, as surgeries were performed at a watershed zone, supplied by the artery of Adamkiewicz, which usually arises on the left at the T8-L2 level [11] and at T9 or T10 in 50 % of patients [1].…”

“…It has been previously suggested that decompression of a previously severely compressed region of the spinal cord may lead to sensory or motor deficits during the early postoperative period [4,8], and reperfusion injury as a mechanism contributing to neural damage has been described in the setting of acute ischemic events [2,6], however, not for chronic conditions such as thoracic stenosis.…”