Postlaminectomy pseudomeningocele. An unsuspected cause of low back pain

Patients with postlaminectomy pseudomeningoceles may present to pain management centers without having been diagnosed previously. Practitioners treating chronic low back pain need to be aware of this potential hazard.

Retrospective analyses of six such cases was made including: clinical signs and symptoms, radiological findings, and possible therapeutic modalities.

In every case, there was a palpable fluctuating mass under the surgical scar, sensory loss in both lower extremities, and limited leg raising; moreover, heel tapping produced pain. Also, every patient had a history of long standing cigarette smoking and multiple spinal surgeries. Radiologically dural saccular or tubular structures were noted at myelograms, magnetic resonance imaging, or computed axial tomography scan, usually at the site of the surgery. In one patient with metallic devices, diagnosis was made by ultrasound.

The need for a complete examination by the pain specialist is emphasized since instrumentation in attempts to perform invasive procedures, i.e., inserting needles in the patients, may result in unintentional puncture of the pseudomeningocele and cerebrospinal fluid leaks. The clinical features accompanying the surgical complications ought to be recognized as a warning signal.