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The patient came 13-June-1999 complaining of neck pain for 5 years
with numbness of both hands with exacerbation of the pain in
the left shoulder. MRI of the cervical spine was requested and the
patient disappeared. The patient then came another time
23-July-2006 with exacerbation of the pain of the left upper limb
for agonizing pain the last week.
On examination: the patient had weak grip and extension left hand
with left triceps muscle. The deep reflexes diminished in the left
and hypalgesia left thumb. MRI cervical spine performed 24-July-2006
showed huge extrusion C5-6 left side.
The patient was operated and discectomy C5-6 was performed. The
dura was as soap bubble thickness, that during dissection the CSF
came to the field with no identifiable source, for what the dura was
covered by 2 layers of muscle harvested from the SCMM aided
with surgicele. Valsalva maneuver confirmed no CSK leak. Routine
closure of the wound with prompt postoperative recover.
Comments: 1. The long
presence of the extrusion in the cervical or the lumbar , not
only decrease the outcome of surgery, but also destroy the natural
tissues, as in this case. The dura was very thin, transparent, which
was the cause of the leak. These elements increase the morbidity and
possible complications during surgery. These factors must be taken
seriously in the presurgical planning. |
