Misplaced intraspinal venous stent causing cauda equina syndrome: illustrative case

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Neurosurgery

Background:

• Endovenous stent placement for deep venous thrombosis (DVT) carries a risk of unintended intraspinal misplacement.
• This complication can lead to severe neurological deficits, including cauda equina syndrome.

Purpose of the Study:

• To highlight the risks associated with endovenous stent placement in the spinal canal.
• To emphasize the importance of advanced imaging techniques in preventing such errors.

Main Methods:

• Case report of a patient with intraspinal stent misplacement causing cauda equina syndrome.
• Systematic literature review of previously reported cases of spinal canal stent misplacement.
• Analysis of imaging modalities used in reported cases.

Main Results:

• In reviewed cases, anteroposterior monoplanar imaging was frequently used, limiting depth perception and structure differentiation.
• The anteroposterior plane is insufficient for accurate stent placement, increasing the risk of intraspinal misplacement.
• Intraspinal stent placement can result in catastrophic neurological consequences.

Conclusions:

• Biplanar or three-dimensional imaging modalities are recommended for iliac venous stent placement to ensure accurate deployment.
• Increased awareness among spine surgeons regarding this complication and its management is crucial.
• Adoption of improved imaging protocols can prevent devastating neurological outcomes.