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http://dx.doi.org/10.3340/jkns.2013.53.1.52

Transdural Nerve Rootlet Entrapment in the Intervertebral Disc Space through Minimal Dural Tear : Report of 4 Cases  

Choi, Jeong Hoon (Department of Neurosurgery, Wooridul Spine Hospital)
Kim, Jin-Sung (Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine)
Jang, Jee-Soo (Department of Neurosurgery, Wooridul Spine Hospital)
Lee, Dong Yeob (Department of Neurosurgery, Wooridul Spine Hospital)
Publication Information
Journal of Korean Neurosurgical Society / v.53, no.1, 2013 , pp. 52-56 More about this Journal
Abstract
Four patients underwent lumbar surgery. In all four patients, the dura was minimally torn during the operation. However, none exhibited signs of postoperative cerebrospinal fluid leakage. In each case, a few days after the operation, the patient suddenly experienced severe recurring pain in the leg. Repeat magnetic resonance imaging showed transdural nerve rootlets entrapped in the intervertebral disc space. On exploration, ventral dural tears and transdural nerve rootlet entrapment were confirmed. Midline durotomy, herniated rootlet repositioning, and ventral dural tear repair were performed, and patients' symptoms improved after rootlet repositioning. Even with minimal dural tearing, nerve rootlets may become entrapped, resulting in severe recurring symptoms. Therefore, the dural tear must be identified and repaired during the first operation.
Keywords
Nerve rootlet entrapment; Lumbar disc herniation; Laminectomy; Discectomy; Dura tear; Dura repair;
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1 Eismont FJ, Wiesel SW, Rothman RH : Treatment of dural tears associated with spinal surgery. J Bone Joint Surg Am 63 : 1132-1136, 1981   DOI
2 Asha MJ, George KJ, Choksey M : Pseudomeningocele presenting with cauda equina syndrome : is a 'ball-valve' theory the answer? Br J Neurosurg 25 : 766-768, 2011   DOI
3 Aydinli U, Karaeminoğullari O, TiŞkaya K, Oztürk C : Dural tears in lumbar burst fractures with greenstick lamina fractures. Spine (Phila Pa 1976) 26 : E410-E415, 2001   DOI
4 Cammisa FP Jr, Eismont FJ, Green BA : Dural laceration occurring with burst fractures and associated laminar fractures. J Bone Joint Surg 71 : 1044-1052, 1989   DOI
5 Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS : Incidental durotomy in spine surgery. Spine (Phila Pa 1976) 25 : 2663-2667, 2000   DOI
6 Couture D, Branch CL Jr : Spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus 15 : E6, 2003
7 Hasegawa K, Yamamoto N : Nerve root herniation secondary to lumbar puncture in the patient with lumbar canal stenosis. A case report. Spine (Phila Pa 1976) 24 : 915-917, 1999   DOI
8 Hodges SD, Humphreys SC, Eck JC, Covington LA : Management of incidental durotomy without mandatory bed rest. A retrospective review of 20 cases. Spine (Phila Pa 1976) 24 : 2062-2064, 1999   DOI
9 Hosono N, Yonenobu K, Ono K : Postoperative cervical pseudomeningocele with herniation of the spinal cord. Spine (Phila Pa 1976) 20 : 2147-2150, 1995   DOI
10 Khan MH, Rihn J, Steele G, Davis R, Donaldson WF 3rd, Kang JD, et al. : Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery : a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976) 31 : 2609-2613, 2006   DOI
11 Lee KS, Hardy IM 2nd : Postlaminectomy lumbar pseudomeningocele : report of four cases. Neurosurgery 30 : 111-114, 1992   DOI
12 Nishi S, Hashimoto N, Takagi Y, Tsukahara T : Herniation and entrapment of a nerve root secondary to an unrepaired small dural laceration at lumbar hemilaminectomies. Spine (Phila Pa 1976) 20 : 2576-2579, 1995   DOI
13 Saxler G, Krämer J, Barden B, Kurt A, Pförtner J, Bernsmann K : The long-term clinical sequelae of incidental durotomy in lumbar disc surgery. Spine (Phila Pa 1976) 30 : 2298-2302, 2005   DOI
14 O'Connor D, Maskery N, Griffiths WE : Pseudomeningocele nerve root entrapment after lumbar discectomy. Spine (Phila Pa 1976) 23 : 1501-1502, 1998   DOI
15 Park DK, Khurana N, Ellman MB, Singh K : Perioperative complications in lumbar spine surgery. Contemp Spine Surg 10 : 1-6, 2009
16 Pavlou G, Bucur SD, van Hille PT : Entrapped spinal nerve roots in a pseudomeningocoele as a complication of previous spinal surgery. Acta Neurochir (Wien) 148 : 215-219; discussion 219-220, 2006   DOI
17 Töppich HG, Feldmann H, Sandvoss G, Meyer F : Intervertebral space nerve root entrapment after lumbar disc surgery. Two cases. Spine (Phila Pa 1976) 15 : 249-250, 1994