Intradural Hematoma and Arachnoid Cyst Following Lumbar Spinal Surgery: A Case Report

• Published in: Canadian journal of neurological sciences 2018-01, Vol.45 (1), p.114-116
• Main Authors: Taccone, Michael S., Theriault, Patrick G., Roffey, Darren M., AlShumrani, Mohamed, Alkherayf, Fahad, Wai, Eugene K.
• Format: Article
• Language: English
• Subjects: Aged; Arachnoid Cysts - diagnostic imaging; Arachnoid Cysts - etiology; Back surgery; Brain diseases; Case reports; Cerebrospinal fluid; Cysts; Electromyography; Epidural; Hematoma; Hematoma - diagnostic imaging; Hematoma - etiology; Humans; Iatrogenesis; Letters to the Editor; Lumbosacral Region - surgery; Magnetic Resonance Imaging; Male; Pathology; Postoperative Complications - diagnostic imaging; Postoperative Complications - physiopathology; Spinal Cord Diseases - surgery; Spinal Fusion - adverse effects; Trauma
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2017.254

When an SIDH occurs, it typically manifests from vascular malformations, tumors, bleeding disorders, anticoagulant therapy, or following a trauma or infection.1-5 Iatrogenic causes of SIDH include diagnostic lumbar punctures and epidural anesthesia.5 Spinal arachnoid cysts are thought to be caused by a congenital deficiency within the arachnoid or adhesions resulting from previous infection or trauma.6 Instances of SIDH following lumbar spine surgery are rare.1,5 Most have been associated with accidental dural tear during the procedure.1 Few cases have been reported following spinal surgery where the dura remained intact.5 Similarly, there are few reports documenting an arachnoid cyst causing acute neurological injury following uncomplicated lumbar spinal surgery.7 To our knowledge, there have been no cases in which the preoperative imaging did not show any evidence of a preexisting cyst. The patient underwent an uncomplicated L4-L5 posterior microdecompression (bilateral decompression via a unilateral approach with preservation of the spinous process and contralateral lamina) under microscopic visualization with L4-L5 minimally invasive transforaminal lumbar interbody fusion using a PEEK (Stryker; Hamilton, ON, Canada) banana-shaped cage and local bone graft. Few cases have reported acute spontaneous arachnoid cyst developing postoperatively and even fewer report concomitant intradural hematomas.2-4 Basaldella et al8 summarizes four theorized mechanisms for arachnoid cyst formations: a ball-valve mechanism; an osmotic gradient; a congenital malformation; and hypersecretory fluid production.