Migration of intracranial hemostatic clip into the lumbar spinal canal causing sacral radiculopathy: a case report
Keigo Yasui1, Yoshihisa Kotani, Yasushi Takeda
1Department of Orthopedic Surgery, Kutchan Kosei Hospital, Hokkaido, Japan.
Study Design:
A case report.
Objectives:
A case of spontaneous migration of intracranial hemostatic clip into the lumbar spinal canal causing a sacral radiculopathy and severe low back pain was presented.
Summary Of Background Data:
Only five cases have been reported in the literature. The first report was described by Oyesiku in 1986; thereafter, four cases have been reported. This serves as the first report clearly describing the relationship between the migrated site of a foreign body and neurologic symptom, as well as achieving a remission of symptom after surgical extirpation.
Methods:
A patient who had received hemostatic clips to the aqueductal stenosis 31 years ago presented with low back pain and sacral radiculopathy. Plain radiography, myelography, and subsequent CT revealed that a metal foreign body was located in the subarachnoid space at L4 level. Laminectomy of L4 and extirpation of the foreign body were performed.
Results:
The foreign body was a hemostatic clip made of cobalt-based alloy that had been applied during the previous intracranial surgery. The clip irritated the adjoined intrathecal nerve root and possibly caused the adhesive arachnoiditis. All symptoms completely disappeared after the extirpation.
Conclusions:
An uncommon case of an intracranial hemostatic clip migrating into the lumbar subarachnoid space as well as causing sacral radiculopathy was reported. The surgical extirpation provided an excellent clinical outcome.
Insights
A rare case of an intracranial hemostatic clip migrating to the lumbar spine caused severe back pain and radiculopathy. Surgical removal of the migrated clip completely resolved the patient's symptoms.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Radiology
Background:
- Intracranial hemostatic clips are rarely reported to migrate.
- Only five cases of migrated hemostatic clips have been documented in medical literature.
- This report details a unique instance of clip migration and its neurological sequelae.
Observation:
- A patient presented with low back pain and sacral radiculopathy 31 years after intracranial surgery for aqueductal stenosis.
- Imaging revealed a migrated hemostatic clip in the lumbar spinal canal (L4 level).
Findings:
- The migrated foreign body was identified as a cobalt-based alloy hemostatic clip.
- The clip caused irritation to the intrathecal nerve root, likely leading to adhesive arachnoiditis.
- Complete symptom resolution was achieved following surgical extirpation of the clip.
Implications:
- This case highlights the potential for delayed complications from intracranial hardware.
- Surgical removal of migrated hemostatic clips can lead to excellent clinical outcomes.
- Understanding the relationship between migrated foreign body location and neurological symptoms is crucial for diagnosis and treatment.
