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Three Cases of Paralysis after Lumbar Surgery
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Posted on: 03/15/2004
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Doctors at the Gifu University of Medicine in Japan report three cases of permanent paralysis. The cause in each case was a missed lesion putting pressure on the spinal cord in the middle of the spine. Symptoms of back and leg pain along with muscle weakness led doctors at first to think the problem was in the lumbar spine.
Imaging studies weren't completely clear. An operation to take pressure off the spinal nerves in the lumbar spine wasn't enough. All three patients got worse, with loss of bladder function, changed reflexes, and extreme muscle weakness.
More testing and an exam of the spine at a level above the lumbar spine showed a tumor in one case. The other two cases involved a cyst, herniated disc, and hardening of a spinal ligament. A second operation relieved the pressure on the spinal cord. However, the delay in diagnosis and treatment resulted in permanent damage to the spinal cord. All three patients had some ongoing neurological problems.
The doctors reporting these cases say the red flag in these cases was the mismatch of symptoms. The patients' symptoms and the MRI of the lumbar area weren't the same. More testing might have shown a loss of sensation higher up. For example, pinprick testing of the trunk would have been positive in at least one case.
Missing a compressive lesion in the thoracic spine doesn't happen very often. The authors conclude that testing must be complete before doing surgery when the symptoms and the exam don't match up.
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References:
Akhko Takeuchi, MD, et al. Thoracic Paraplegia Due to Missed Thoracic Compressive Lesions after Lumbar Spinal Decompression Surgery. In Journal of Neurosurgery: Spine. January 2004. Vol. 100. No. 1. Pp. 71-74.
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