Hirayama and Granuloma-The Affinity Saga

Foreign-body granulomas secondary to synthetic materials used in neurosurgery are common. It has been reported that most of them occur after brain surgery than spinal surgery. Hirayama disease, which presents as a slow progressive upper limb muscle weakness and subsequently atrophy, obligates surgical intervention when the conservative management fails. It is managed by posterior cervical surgery followed by dural repair, while anterior cervical surgery is also an option. The component present in duroplasty material, ReDura, may cause exuberant granuloma formation. Foreign-body granuloma at the site of dural repair secondary to the synthetic dural component can cause spinal cord compression worsening the symptoms, requiring surgery. We hereby report a case of a young male with Hirayama disease who underwent posterior cervical surgery followed by duroplasty. The mass effect by the granuloma, secondary to dural repair, was relieved surgically and patient improved neurologically.