Postlaminectomy membrane with dynamic spinal cord compression disclosed with computed tomographic myelography: a case
Takahiro Kitahara1, Junya Hanakita1, Toshiyuki Takahashi1
1Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan.
Introduction:
It has been hypothesized that postoperative epidural scar, postlaminectomy membrane, may be responsible for late neurological deterioration after cervical laminectomy in some cases, but there is a lack of radiological studies in the literature showing the clinical significance of postlaminectomy membrane. We describe a rare case with radiological evidence of dynamic spinal cord compression caused by the postlaminectomy membrane, which may have been related to neurological deterioration.
Case Presentation:
A 73-year-old male developed recurrent cervical myelopathy 6 months after C4-C6 laminectomy. In addition to atlantoaxial subluxation and kyphotic deformity, dynamic spinal cord compression by the postlaminectomy membrane was identified on computed tomographic myelography. The patient underwent atlantoaxial fixation and C3-C7 posterior decompression and fixation combined with removal of the thick and firm postlaminectomy membrane adhering to the dura mater. Histopathological findings of the postlaminectomy membrane revealed chronic inflammation around exogenous materials, presumably surgical materials remaining after the first operation, in the thick fibrous tissue. The patient's symptoms improved without recurrence of symptoms and postlaminectomy membrane formation for 3 years.
Discussion:
Compared with cervical laminoplasty, cervical laminectomy entails several postoperative problems, including postlaminectomy membrane formation. Postlaminectomy membranes may cause dynamic effects related to late neurological deterioration, and the evaluation of dynamic factors is important for neurological recurrence after cervical laminectomy. In the present case, chronic inflammation caused by surgical materials remaining after the first operation might have contributed to the rapid development of the postlaminectomy membrane.
Insights
Postlaminectomy membranes can cause dynamic spinal cord compression, leading to neurological deterioration after cervical laminectomy. This case highlights the importance of evaluating dynamic factors for recurrence.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Radiology
Background:
- Postlaminectomy membrane formation is a known complication after cervical laminectomy.
- Radiological evidence of its clinical significance, particularly dynamic spinal cord compression, is limited.
- This study presents a rare case with radiological findings.
Purpose of the Study:
- To describe a case of dynamic spinal cord compression caused by a postlaminectomy membrane.
- To illustrate the potential link between postlaminectomy membranes and late neurological deterioration.
- To emphasize the importance of evaluating dynamic factors in recurrent cervical myelopathy.
Main Methods:
- A 73-year-old male with recurrent cervical myelopathy post-laminectomy was evaluated.
- Computed tomographic myelography identified dynamic spinal cord compression by a postlaminectomy membrane.
- Surgical intervention included decompression, fixation, and membrane removal, followed by 3-year follow-up.
Main Results:
- Radiological evidence of dynamic spinal cord compression by the postlaminectomy membrane was confirmed.
- Histopathology revealed chronic inflammation around residual surgical materials within the membrane.
- The patient experienced symptom improvement and no recurrence for 3 years post-surgery.
Conclusions:
- Postlaminectomy membranes can cause dynamic spinal cord compression, contributing to late neurological deterioration.
- Cervical laminectomy has potential postoperative issues, including membrane formation, compared to laminoplasty.
- Evaluating dynamic factors is crucial for managing neurological recurrence after cervical laminectomy.
