Rare Complications of Cervical Spine Surgery: Pseudomeningocoele
Tamir Ailon1, Justin S Smith2, Ahmad Nassr3
1University of British Columbia, Vancouver, British Columbia, Canada.
Study Design:
This study was a retrospective, multicenter cohort study.
Objectives:
Rare complications of cervical spine surgery are inherently difficult to investigate. Pseudomeningocoele (PMC), an abnormal collection of cerebrospinal fluid that communicates with the subarachnoid space, is one such complication. In order to evaluate and better understand the incidence, presentation, treatment, and outcome of PMC following cervical spine surgery, we conducted a multicenter study to pool our collective experience.
Methods:
This study was a retrospective, multicenter cohort study of patients who underwent cervical spine surgery at any level(s) from C2 to C7, inclusive; were over 18 years of age; and experienced a postoperative PMC.
Results:
Thirteen patients (0.08%) developed a postoperative PMC, 6 (46.2%) of whom were female. They had an average age of 48.2 years and stayed in hospital a mean of 11.2 days. Three patients were current smokers, 3 previous smokers, 5 had never smoked, and 2 had unknown smoking status. The majority, 10 (76.9%), were associated with posterior surgery, whereas 3 (23.1%) occurred after an anterior procedure. Myelopathy was the most common indication for operations that were complicated by PMC (46%). Seven patients (53%) required a surgical procedure to address the PMC, whereas the remaining 6 were treated conservatively. All PMCs ultimately resolved or were successfully treated with no residual effects.
Conclusions:
PMC is a rare complication of cervical surgery with an incidence of less than 0.1%. They prolong hospital stay. PMCs occurred more frequently in association with posterior approaches. Approximately half of PMCs required surgery and all ultimately resolved without residual neurologic or other long-term effects.
Insights
Pseudomeningocele (PMC) is a rare complication following cervical spine surgery, occurring in less than 0.1% of cases. While these events prolong hospital stays, they are successfully treated without long-term effects.
Area of Science:
- Neurosurgery
- Spine Surgery
- Cerebrospinal Fluid Dynamics
Background:
- Pseudomeningocele (PMC) is a rare but significant complication after cervical spine surgery.
- Investigating rare complications like PMC is challenging due to limited case numbers.
Purpose of the Study:
- To evaluate the incidence, presentation, treatment, and outcomes of postoperative pseudomeningocele (PMC) after cervical spine surgery.
- To pool collective experience from a multicenter study to better understand PMC.
Main Methods:
- Retrospective, multicenter cohort study.
- Inclusion criteria: patients over 18 who underwent cervical spine surgery (C2-C7) and developed a postoperative PMC.
- Data collected on patient demographics, surgical approach, indication, and PMC management.
Main Results:
- Thirteen patients (0.08%) developed postoperative PMC.
- PMC was more common after posterior surgery (76.9%) and associated with myelopathy (46%).
- Half of the PMCs required surgical intervention; all resolved without residual effects, though hospital stay was prolonged.
Conclusions:
- Pseudomeningocele (PMC) is a rare complication (<0.1%) of cervical spine surgery.
- Posterior approaches are more frequently associated with PMC development.
- All cases of PMC resolved successfully, with or without surgery, indicating a favorable prognosis.
