Motor Injury by Compression of Spinal Cord at Cervical Level During Surgery
Journal of Spine Research and Surgery
They were classified into three groups, the first included complications related to the approach and surgical procedure, such as laryngeal complications (dysphonia, aphonia), tracheal, esophageal (rupture, laceration, swallowing discomfort) and pharyngeal, injury to the laryngeal nerves, rupture of large vessels, alteration of the sympathetic-cervical chain, the increase of the neurological deficit (radicular, medullar) as a direct consequence of J Spine Res Surg 2019; 1 (1): 023-028 Journal of
... 023-028 Journal of Spine Research and Surgery 27 the intervention, the dural laceration or the cerebrospinal fluid fistula, the soft tissue hematomas and the respiratory problems derived from these, the infection superficial or deep (discitis, meningitis, abscess). The second group included the complications derived from the arthrodesis material, both graft (extrusion, collapse, fracture), and instrumentation (plaque fracture, rupture, extrusion of the screws, extrusion of the Inter somatic box). Systemic complications constituted the third group. Duration of the complication We established as a transitory complication that which did not last after three months, and as a permanent complication, that which remained past this time. Cerebrospinal fluid leakage (CSF) is a potential complication of cranial and spinal surgery. Postoperative CSF leak can induce delayed healing, wound infection and meningitis. . DuraSeal® (Covidien, Waltham, MA, USA) It is a synthetic material. Product that has been increasingly used to facilitate tightness. Repair of dural defects after cranial and spinal surgery. DuraSeal® has been shown to be safe and effective in clinical studies and approved in 2005. By the Food and Drug Administration (FDA) . CSF leak can cause delayed healing of surrounding tissues, such as skin, muscles and bones, due to its caustic effect . Other potential complications include meningitis and severe headaches from CSF depletion. The goal, therefore, once a CSF leak is identified, is to stop the leak. DuraSeal® is a self-curing agent that quickly forms a firm, watertight hydrogel layer several seconds after application on the dural surface. Compared to fibrin glue, there is a "higher resistance of tissue adhesion and resistance to breakage". The firm layer is robust enough to withstand irrigation and gentle suction maneuvers without risk of eviction. These properties are advantageous to affect a hermetic barrier to minimize the risk of leakage of CSF . After review of the literature [3-5] we have found a case similar to the one we are dealing with: A case of compression of the cervical cord has also been reported in a patient who underwent anterior cervical decompression C5-C6 and fusion that suffered a CSF leak when removing the posterior longitudinal ligament. Using DuraSeal® as primary sealant . Three hours after the operation, the patient developed progressive motor weakness of the upper and lower extremities. During the emerging exploration and decompression, the surgeons determined that the expanded hydrogel was the cause of the compression  . Differences between the two cases: In our case the lesion appears during the intervention, therefore it seems unlikely that it is the mass effect of the duraseal that has not had time to consolidate, the one responsible for the motor injury. Rather, it would be a repeated microtrauma during the release of the common ligament. Posterior or a contact during the disc excrescence causes the injury. In the other cases examined, the time necessary for the appearance of neurological locality was much higher, 9 days in Lumbar pathology; In experimental studies, it took between 3 days and 2 weeks to obtain a neurological lesion [4, 5] . A review in the literature reveals an extensive list of complications in anterior cervical spine surgery. Although, many of them are extremely rare  . The percentage of complications in anterior cervical surgery ranges from 5% to 30% of cases  , and 9.8% if we consider only complications that remain permanently as morbidity. In some studies they speak of the epidural hematoma as a complication of anterior cervical surgery. It occurs in 1% of surgeries  . The appearance of a new neurological deficit is a rare complication. If the neurological deficit becomes evident immediately after the intervention, the most probable cause of the deficit is due to surgical trauma or problems related to the position or manipulation of the neck during intubation  . Between 1.3% to 11% there is a new radicular deficit, and from 0.7 to 3.1% worsening of the spinal deficit  . The rupture of the dura mater and cerebrospinal fluid fistula occur between 3.1% to 14% . Surgery carries a risk with percentages of probabilities of improvement, but also of complications and are likely not assurances of improvement if not probability of improvement and also probability or possibility of complications.