PDF(Pubmed)
Abstract：
Lumbar spinal stenosis, a narrowing of the spinal canal around the spinal neurovascular structures, is a common etiology for lower back and leg pain in older people. Sciatica, a frequent symptom of lumbar spinal stenosis, typically presents with sharp and/or aching pain that originates in the buttock, extends to the thigh, and radiates into the foot and toes; in addition, it can be accompanied by weakness of the associated lower extremity. In individuals with sciatica-related persistent symptoms or functional limitations or both, spinal decompression surgery may be necessary. A cerebrospinal fluid leak is a potential complication of lumbar spinal stenosis surgery; it is frequently--yet not always--accompanied by a postural headache. The cerebrospinal fluid leak can result from an intraoperative tear or postoperatively. Albeit a more common adverse event after body contouring surgery, seroma--a postoperative serous fluid collection that is usually detectable as a palpable or visible fluid wave on clinical examination--has also been observed as a complication following lumbar spinal stenosis surgery. A man who experienced an intra-operative accidental dural tear during lumbar spinal stenosis surgery is described. A large cerebrospinal fluid leak that involved both the laminectomy bed and the subcutaneous tissue of his back subsequently developed; the leak eventually presented as duro-cutaneous fistulas without headache. His doctors misinterpreted the cerebrospinal fluid leak as a seroma; this may have occurred since not only did the color of the persistent and continuously dripping fluid varied from being clear to slightly tinged pink, but also the patient never had a headache or any other symptoms associated with a cerebrospinal fluid leak. When his lower back was appropriately evaluated with magnetic resonance imaging, the diagnosis of a large cerebrospinal fluid leak was established. In conclusion, lumbar spinal stenosis back surgery can be associated with postoperative complications, including cerebrospinal fluid leak and--less frequently--seroma. However, following lumbar spinal stenosis surgery, the absence of a headache does not exclude the possibility of a cerebrospinal fluid leak. Also, the presence of fluid leaking from the surgical site after lumbar spinal stenosis back surgery should not only prompt the clinician to entertain the possibility of a surgery-associated cerebrospinal fluid leak but also to obtain additional diagnostic studies--such as magnetic resonance imaging--to establish the diagnosis.
摘要：
腰椎管狭窄症,脊髓神经血管结构周围的椎管变窄，是老年人下背部和腿部疼痛的常见病因。坐骨神经痛,腰椎管狭窄症的常见症状,通常表现为起源于臀部的剧烈和/或疼痛，延伸到大腿，并辐射到脚和脚趾；此外，它可以伴随着相关的下肢无力。在与坐骨神经痛相关的持续症状或功能限制或两者兼有的个体中，脊柱减压手术可能是必要的。脑脊液漏是腰椎管狭窄症手术的潜在并发症；它经常-但不总是-伴有姿势性头痛。脑脊液漏可能是由于术中撕裂或术后所致。尽管这是身体轮廓手术后更常见的不良事件，血清-一种术后浆液性液体收集，通常在临床检查中可检测为可触及或可见的液体波-也被观察为腰椎管狭窄症手术后的并发症。描述了一名在腰椎管狭窄症手术中经历了术中意外硬膜撕裂的男子。随后出现了涉及椎板切除术床和背部皮下组织的大脑脊液漏；泄漏最终表现为硬皮瘘，没有头痛。他的医生将脑脊液漏误解为血清肿；这种情况可能发生了，因为不仅持续不断地滴下的液体的颜色从清澈到略带粉红色不等，但患者从未出现过头痛或任何其他与脑脊液漏相关的症状。当磁共振成像对他的下背部进行适当评估时，确定了大的脑脊液漏的诊断。总之,腰椎管狭窄背部手术可能与术后并发症有关，包括脑脊液漏和-很少见-血清肿。然而,腰椎管狭窄手术后，没有头痛并不排除脑脊液漏的可能性。此外，腰椎管狭窄背部手术后，手术部位存在液体渗漏，不仅应提示临床医生考虑手术相关脑脊液漏的可能性，还应获得额外的诊断研究，如磁共振成像，以建立诊断。
