• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.1042-1046
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• 2001

The incidence of paraplegia following drain of cerebrospinal fluid(CSF) by lumbar puncure below a spinal block is rare, and most of them occurred in spinal tumor. We report a case of acute paraplegia following lumbar puncture for computed tomography myelography(CTM) in a 42-year-old man who sustained a cervical disc herniation. Four hours after lumbar puncture for CTM, sudden paraplegia was developed. After emergent anterior cervical discectomy and fusion with cervical plating, the patient recovered completely. To the authors' knowledge, this is the first case of spinal shock complicating lumbar puncture for routine myelography in a patient with cervical disc herniation. The prompt recognition of this unusual complication of lumbar puncture may lead to good clinical outcome. Instead of CTM requiring lumbar puncture, MRI should be considered as the initial diagnostic procedure in a patient of cervical disc herniation associated with myelopathy. We discuss the possible mechanisms of acute paraplegia following lumbar puncture with literature review.

• Journal of Korean Neurosurgical Society
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• v.29 no.12
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• pp.1642-1649
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• 2000

Objectives : Transverse myelitis(TM) is characterized by bilateral motor, sensory, and autonomic dysfunction of the spinal cord in the absence of pre-existing neurologic disease. It is an uncommon but not rare condition. But it remains as poorly understood syndrome not only etiologically but also in terms of its clinical behavior. Neurosurgically, It is often quite difficult to distinguish from other surgical intramedullary lesions. We present our clinical experiences of TM in order to assess its clinical behavior and to define the radiological characteristics that can distinguish TM from other intramedullary lesions. Methods : From June 1991 to May 1997, twenty-nine patients with transverse myelitis were admitted to our department. All cases revealed acute or subacute syndrome of non-compressive myelopathy and intramedullary lesions in the MRI. We analyze the radiological data and medical records retrospectively. Results : Patients ranged in age from 16 to 66 years, with 22 males and 7 females. Mean follow-up period was 53 months. For the offending levels, cervical was 5, thoracic 21, and lumbar 3 in number. The patients who presented the return of symptoms after a diminution or abatement of initial symptoms were 7(24%). In the MRI, TM showed typical characteristics of high signal intensity lesions in the center of spinal cord in T2 weighted images and low- to iso-signal intensity in T1 weighted images. A focal nodular enhancement pattern was observed in 58.6%(17/29) of the patients. MR follow-up studies were done in the 21 patients and radiological improvement were verified. Biopsies were done in 3 patients. Normal to good outcome was achieved in 62% of the patients. Conclusion : Transverse myelitis has characteristic radiological findings that can be distinguished from other intramedullary lesions. In our series, it is associated with significant recurrence rates thus, should not be considered a selflimiting disease with good prognosis.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.534-539
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• 2017

Objective : Patients with hematological malignancies frequently encounter spine-related symptoms, which are caused by disease itself or process of treatment. However, there is still lack of knowledge on their epidemiology and clinical courses. The purpose of this article is to review clinical presentations and surgical results for spinal involvement of hematologic malignancies. Methods : From January 2011 to September 2014, 195 patients (98 males and 97 females) suffering from hematological malignancies combined with spinal problems were retrospectively analyzed for clinical and radiological characteristics and their clinical results. Results : The most common diagnosis of hematological malignancy was multiple myeloma (96 patients, 49.7%), followed by chronic myeloid leukemia (30, 15.2%), acute myeloid leukemia (22, 11.2%), and lymphoma (15, 7.56%). The major presenting symptoms were mechanical axial pain (132, 67.7%) resulting from pathologic fractures, and followed by radiating pain (49, 25.1%). Progressive neurologic deficits were noted in 15 patients (7.7%), which revealed as cord compression by epidural mass or compressive myelopathy combined with pathologic fractures. Reconstructive surgery for neurologic compromise was done in 16 patients. Even though surgical intervention was useful for early paralysis (Frankel grade D or E), neurologic recovery was not satisfactory for the progressed paralysis (Frankel grade A or B). Conclusion : Hematological malignancies may cause various spinal problems related to disease progression or consequences of treatments. Conservative and palliative treatments are mainstay for these lesions. However, timely surgical interventions should be considered for the cases of pathologic fractures with progressive neurologic compromise.