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Transient long segment spinal cord hyperintensity after anterior cervical discectomy
Hiroyoshi Akutsu1, Kiyoyuki Yanaka, Noriaki Sakamoto
1Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Summary
A cervical disc herniation caused spinal cord issues. Surgery led to new symptoms and MRI changes, likely due to edema and trauma, highlighting potential surgical complications.
Area of Science:
- Neurosurgery
- Neuroradiology
- Spinal Cord Imaging
Background:
- A 69-year-old male presented with progressive bilateral foot numbness and gait disturbance.
- Cervical magnetic resonance (MR) imaging identified a large C5-6 disc herniation causing significant spinal cord compression.
- Spinal cord hyperintensity on T2-weighted images at C5-6 indicated cord compromise.
Observation:
- Postoperatively, the patient experienced new-onset severe left-sided hemiparesis and lower extremity weakness.
- Follow-up MR imaging revealed extensive T2 hyperintensity from C3 to T2, indicating a prolonged segment of spinal cord involvement.
- This extensive hyperintensity resolved after two weeks of steroid treatment.
Findings:
- Persistent, localized C5-6 hyperintensity suggests spinal cord degeneration from ischemia and trauma secondary to the initial disc herniation.
- Transient, long-segment hyperintensity is attributed to spinal cord edema, possibly from minor surgical trauma to an already compromised cord.
- The case highlights the potential for significant radiological and neurological changes even after meticulous surgical decompression.
Implications:
- Clinicians must recognize that spinal cord decompression surgery, even when carefully performed, can lead to distinct radiological findings and neurological deficits.
- Understanding the difference between ischemic/traumatic degeneration and transient edema is crucial for accurate diagnosis and management post-operatively.
- This case underscores the importance of careful surgical technique and vigilant post-operative monitoring in patients with cervical disc herniation.