Diário da Espinha

A Rare Complication of Lumbar Spine Surgery: Pneumocephalus

Abstract

Andarcia Bañuelos Cesar, Cortes Garcia Pedro, Herrera Perez Mario Ulises and Deniz Rodriguez Bernabe

Purpose: Pneumocephalus is an uncommon but serious complication of spinal surgery and its management and pathophysiology is not widely recognized. Incidence of symptomatic tension pneumocephalus secondary to posterior spinal arthrodesis is unknown. We describe a case of symptomatic tension pneumocephalus in the postoperative period of lumbar arthrodesis surgery, causes, risk factors, treatment and a review of the literature about this uncommon complication.

Methods: The clinical findings, radiological studies (Magnetic resonance imaging and CT scan), and treatment were presented.

Results: We report a rare case of a 41 year old woman with diagnosis of L3-L4, L4- L5 discopathy and left discal herniation L4-L5. A posterior spinal arthrodesis L3-L5, L3-L4 and L4-L5 discectomies and release of the left L5 root, was performed without apparent complications. 24 hours after surgery the patient developed generalized headache, neck stiffness, and dysarthria. MRI and CT scan revealed a huge pneumocephalus in the subarachnoid space, predominantly in the left frontal lobe without midline shift, which originates in the lumbar spinal canal. Treatment: The patient was treated conservatively, featuring 72 hours from progressive neurological improvement, up to clinical and radiological normalization after 7 days.

Conclusions: Pneumocephalus is a rare but potentially serious complication of spine surgery related in most cases with inadvertent dural tear during surgery. Most collections are small, behave benign, and respond to conservative therapy. In the majority of patients with pneumocephalus, a conservative approach consisting of bedrest, hyperhydration, analgesics, sedatives, and antiemetics is adequate, and symptoms resolve in a few weeks. In the present case with inadvartent CSF fistula, the vacuum drainage system predisposed the patient to pneumocephalus. A high degree of suspicion is needed to make the diagnosis, prompt treatment, and remedy of the source of air to prevent unwanted morbidity and mortality.