The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Clinical Experience of Pain Management for Postlaminectomy Syndrome due to Pseudomeningocele -A case report-

가성수막류에 의한 척추수술 후 증후군 환자의 통증치료경험 -증례보고-

  • Cho, Hye Ran (Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center) ;
  • Han, Sang Ji (Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center) ;
  • Park, Sang Chul (Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center) ;
  • Kwon, Young Eun (Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center) ;
  • Lee, Jun Hak (Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center)
  • 조혜란 (전주예수병원 마취통증의학과) ;
  • 한상지 (전주예수병원 마취통증의학과) ;
  • 박상철 (전주예수병원 마취통증의학과) ;
  • 권영은 (전주예수병원 마취통증의학과) ;
  • 이준학 (전주예수병원 마취통증의학과)
  • Received : 2006.05.08
  • Accepted : 2006.08.24
  • Published : 2006.12.30
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Abstract

Postlaminectomy syndrome is characterized by persistent low back pain and radiculopathy of the legs after surgery of the spine. Pseudomeningocele is an uncommon cause of postlaminectomy syndrome; it is characterized by an extradural collection of cerebrospinal fluid (CSF) without dural covering, resulting from unrecognized dural tears at the time of lumbar surgery. In most cases, surgery to repair a pseudomeningocele is recommended. However if surgical treatment does not yield symptomatic relief, then conservative treatment should be considered. We treated a patient with a pseudomeningocele after spine surgery in which selective transforaminal epidural block produced long-term relief of symptoms. Here we describe the management of this patient.

Keywords

References

  1. Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB: Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res 1981; 157: 191-9
  2. Fiume D, Sherkat S, Callovini GM, Parziale G, Gazzeri G: Treatment of the failed back surgery syndrome due to lumbo-sacral epidural fibrosis. Acta Neurochir Suppl 1995; 64: 116-8
  3. Barron JT: Radiologic case study. Lumbar pseudomeningocele. Orthopedics 1990; 13: 608-9
  4. Lee KS, Hardy IM 2nd: Postlaminectomy lumbar pseudomeningocele: report of four cases. Neurosurgery 1992; 30: 111-4 https://doi.org/10.1227/00006123-199201000-00020
  5. Pheasant HC, Dyck P: Failed lumbar disc surgery: cause, assessment, treatment. Clin Orthop Relat Res 1982; 164: 93-109
  6. Salenius P, Laurent LE: Results of operative treatment of lumbar disc herniation. A survey of 886 patients. Acta Orthop Scand 1977; 48: 630-4 https://doi.org/10.3109/17453677708994809
  7. Hyndman OR, Gerber WF: Spineal extradural cysts, congenital and acquired. Report of cases. J Neurosurg 1946; 3: 474-86 https://doi.org/10.3171/jns.1946.3.6.0474
  8. Jones AA, Stambough JL, Balderston RA, Rothman RH, Booth RE Jr: Long-term results of lumbar spine surgery complicated by unintended incidental durotomy. Spine 1989; 14: 443-6 https://doi.org/10.1097/00007632-198904000-00021
  9. Wang JC, Bohlman HH, Riew KD: Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up eighty-eight patients. J Bone Joint Surg Am 1998; 80: 1728-32 https://doi.org/10.2106/00004623-199812000-00002
  10. Bak KH, Kim YS, Kim JM, Ko Y, Oh SH, Oh SJ, et al: Iatrogenic pseudomeningocele after lumbar laminectomies. J Korean Neurosurg Soc 1996; 25: 2098-102
  11. Han SM, Kim TH, Lim YJ, Lee SC: L2 root block in failed back surgery syndrome. Korean J Pain 2000; 13: 247-50
  12. Winnie AP, Hartman JT, Meyers HI. Jr, Ramamurthy S, Barangan V: Pain clinic. II. Intradural and extradural corticosteroids for SClatica. Anesth Analg 1972; 51: 990-1003
  13. Pountain GD, Keegan AL, Jayson MI: Impaired fibrinolytic activity in defined chronic back pain syndromes. Spine 1987; 12: 83-6 https://doi.org/10.1097/00007632-198703000-00002
  14. Schofferman J, Reynolds J, Herzog R, Covington E, Dreyfuss P, O'Neill C: Failed back surgery: etiology and diagnostic evaluation. Spine J 2003; 3: 400-3 https://doi.org/10.1016/S1529-9430(03)00122-0
  15. Eismont FJ, Wiesel SW, Rothman RH: Treatment of dural tears associated with spinal surgery. J Bone Joint Surg Am 1981; 63:1132-6 https://doi.org/10.2106/00004623-198163070-00010
  16. Bosacco SJ, Gardner MJ, Guille JT: Evaluation and treatment of dural tears in lumbar spine surgery. Clin Orthop Relat Res 2001; 389: 238-47 https://doi.org/10.1097/00003086-200108000-00033