Acute spinal subdural haematoma complicating a posterior spinal instrumented fusion for congenital scoliosis:A case report

BACKGROUND Acute spinal subdural haematoma(ASSH)is a rare and potentially devastating condition with a variable prognosis.Previously described subdural haematomas were thought to have occurred spontaneously or be related to major or minor iatrogenic or traumatic injuries caused by surgery,spinal puncture or epidural anaesthesia.Other contributing pathologies have been described,such as intradural tumours or spinal arteriovenous malformations.ASSH has also been associated with anticoagulation therapy,haemostatic abnormalities and risk factors such as pregnancy.To the best of our knowledge,this case study described the first reported occurrence of an ASSH during spinal surgery in a paediatric patient.The patient was not known to have any coagulopathies,and no obvious vascular lesions were documented.The surgical procedure did not directly involve the dura mater,and no evident intraoperative dural tears were found.CASE SUMMARY We reported and discussed a case of ASSH complicating a posterior spinal instrumented fusion during surgery for paediatric congenital scoliosis.This condition has not been previously described.We made recommendations for facing such an occurrence,explored its aetiology in the context of malformation and discussed the benefits of neuromonitoring during scoliosis correction and the management protocol.We conducted a PubMed literature review for cases of paediatric ASSH and other closely related disorders.We reviewed recommendations regarding neuromonitoring and treatment management in such cases.CONCLUSION ASSH is a rare complication of posterior spinal instrumented fusion.Published cases are more often associated with anticoagulation therapy or coagulopathy.Neuromonitoring is strongly recommended to detect and assess neurological status,thus enabling rapid diagnosis and treatment and facilitating early spinal decompression and a return to a normal neurological status.

Thoracic and Lumbar Spine Fracture, Type C of Magerl: About Two Cases and Review of Literature

Introduction: Thoracic and lumbar spine fracture, type C of MAGERL is one of the most biomechanically and neurologically unstable lesions, induced by significant damage to the bone, disk and ligament complex. Materials and Methods: We report two cases of Thoracic and lumbar fracture, type C of MAGERL hospitalized in the Neurosurgery department of the Grand Yoff General Hospital in Dakar during a period from June 2014 to June 2017. Observations: 1st case: 44-year-old patient, referred from abroad because of multi systemic trauma related on road traffic accident. On physical examination sustained a thoracic spine trauma classified ASIA D. Body CT scan showed T4 - T5 fracture-dislocation Type C of MAGERL, multiple ribs fracture with a right slight haemothorax, a sternal, a left humerus and scapulas fracture. Thoracic Posterior approach was done using laminar hooks. Clinical and anatomical results are good. 2nd case: 20-year-old patient, referred for thoraco-lumbar trauma because of occupational accident. The initial clinical examination classified it ASIA B. CT scan investigation, demonstrated a L1-L2 fracture type C of MARGEL. Thoraco lumbar spine posterior approach was done using pedicular screw fixation. Two years after trauma the patient recovered completely from his paraplegia. Conclusion: Thoracic and lumbar spine fractures, type C of MAGERL are compelling and instable fracture. Performing posterior instrumentation can achieve a good stabilization and reduction of the lesion.

Comparison of simple discectomy and instrumented posterior lumbar interbody fusion for treatment of lumbar disc herniation combined with Modic endplate changes

Background The purpose of this retrospective study was to compare the surgical outcomes of simple discectomy and instrumented posterior lumbar interbody fusion （iPLIF） in patients with lumbar disc herniation and Modic endplate changes.Our hypothesis was that iPLIF could provide better outcome for patients with refractory lumbar disc herniation and Modic changes （LDH-MC）.Methods Ninety-one patients with single-segment LDH-MC were recruited.All patients experienced low back pain as well as radicular leg pain,and low back pain was more severe than leg pain.Forty-seven patients were treated with discectomy and 44 were treated with iPLIE The outcomes of both low back pain and radicular leg pain using visual analogue scale （VAS） as well as the clinical outcome related to low back pain using Japanese Orthopaedic Association （JOA） score were assessed before and 18 months after surgery,respectively.Results Both low back and leg pain were significantly improved 18 months after simple discectomy and iPLIE Compared to patients undergoing simple discectomy,low back pain was significantly reduced in patients undergoing iPLIE but there was no significant difference in leg pain between two groups.Solid fusion was achieved in all patients who underwent iPLIF.Conclusions In patients with LDH-MC,iPLIF can yield significantly superior outcome on the relief of low back pain compared to simple discectomy.Simple discectomy can relieve radicular leg pain as efficient as iPLIE Accordingly,iPLIF seems to be a reliable treatment for patients with LDH-MC and predominant low back pain.