J Korean Neurosurg Soc.  2014 Dec;56(6):521-526. 10.3340/jkns.2014.56.6.521.

Radicular Compression by Intraspinal Epidural Gas Bubble Occurred in Distant Two Levels after Lumbar Microdiscectomy

• Lee CW
• Yoon KJ
• Ha SS
• Kang JK

• KMID: 2191151
• DOI: http://doi.org/10.3340/jkns.2014.56.6.521

Abstract

The authors report a case of symptomatic epidural gas accumulation 2 weeks after the multi-level lumbar surgery, causing postoperative recurrent radiculopathy. The accumulation of epidural gas compressing the dural sac and nerve root was demonstrated by CT and MRI at the distant two levels, L3-4 and L5-S1, where vacuum in disc space was observed preoperatively and both laminectomy and discectomy had been done. However, postoperative air was not identified at L4-5 level where only laminectomy had been done in same surgical field, which suggested the relationship between postoperative epidural gas and the manipulation of disc structure. Conservative treatment and needle aspiration was performed, but not effective to relieve patient's symptoms. The patient underwent revision surgery to remove the gaseous cyst. Her leg pain was improved after the second operation.

Keyword

Epidural gas; Vacuum phenomenon; Lumbar spine; Recurrent radiculopathy; Spinal surgery

MeSH Terms

Diskectomy
Humans
Laminectomy
Leg
Magnetic Resonance Imaging
Needles
Radiculopathy
Vacuum

Figure

• 

  Fig. 1 Preoperative sagittal CT and magnetic resonance imaging findings. A sagittal computed tomography (A : L2-3, B : L5-S1) and magnetic resonance image (C) reveal disc herniation containing air in L2-3, L5-S1 level. Vacuum phenomenon is also noted within intervertebral disk space in L2-3, L5-S1 level.

• 

  Fig. 2 Postoperative sagittal computed tomography and magnetic resonance imaging findings (2 weeks after the first operation). A : A sagittal T2-weighted magnetic resonance image demonstrates a signal void compressing thecal sac and nerve roots at L3 body and L5-S1 disc level. Granulation tissue (arrow) around the cyst is seen. B : A sagittal computed tomography shows the mass of low density indicating air bubble at L3 body and L5-S1 disc level.

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  Fig. 3 Series of computed tomography finding. A : Postoperative computed tomography imaging findings (2 weeks after the first operation). B : Computed tomography imaging (after needle aspiration) : the amount of epidural gas was decreased. C : Computed tomography imaging (1 week after the needle aspiration) : the amount of epidural gas increased again. D : Computed tomography imaging findings (after the revision surgery). E : Computed tomography imaging findings (1 year after the revision surgery).

• 

  Fig. 4 Microscopic finding of the operative field in revision surgery. Dissected wall of gaseous cyst (arrow) is seen at inferolatral portion of nerve root (asterisk).

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