Epidural lipomatosis and congenital small spinal canal in spinal anaesthesia: A case report and review of the literature

被引:7
作者
Flisberg P. [1 ]
Thomas O. [1 ]
Geijer B. [2 ]
Schött U. [1 ]
机构
[1] Department of Intensive and Perioperative Care, Lund University Hospital
[2] Department of Radiology, Halmstad Central Hospital, Halmstad
关键词
Spinal Canal; Spinal Anaesthesia; Spinal Stenosis; Lumbar Spinal Stenosis; Lipomatosis;
D O I
10.1186/1752-1947-3-128
中图分类号
学科分类号
摘要
Introduction. Complications after lumbar anaesthesia and epidural blood patch have been described in patients with congenital small spinal canal and increased epidural fat or epidural lipomatosis. These conditions, whether occurring separately or in combination, require magnetic resonance imaging for diagnosis and grading, but their clinical significance is still unclear. Case presentation. A 35-year-old Caucasian woman who was undergoing a Caesarean section developed a longstanding L4-L5 unilateral neuropathy after the administration of spinal anaesthesia. There were several attempts to correctly position the needle, one of which resulted in paraesthesia. A magnetic resonance image revealed that the patient's bony spinal canal was congenitally small and had excess epidural fat. The cross-sectional area of the dural sac was then reduced, which left practically no free cerebrospinal fluid space. Conclusion. The combination of epidural lipomatosis of varying degrees and congenital small spinal canal has not been previously discussed with spinal anaesthesia. Due to the low cerebrospinal fluid content of the small dural sac, the cauda equina becomes a firm system with a very limited possibility for the nerve roots to move away from the puncture needle when it is inserted into the dural sac. This constitutes risks of technical difficulties and neuropathies with spinal anaesthesia. © 2009 Flisberg et al; licensee BioMed Central Ltd.
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共 15 条
[1]  
Borre D.G., Borre G.E., Aude F., Palmieri G.N., Lumbosacral epidural lipomatosis: MRI grading, Eur Radiol, 13, pp. 1709-1721, (2003)
[2]  
Pinkhardt E.H., Sperfeld A.D., Bretschneider V., Unrath A., Ludolph A.C., Kassubek J., Is spinal epidural lipomatosis an MRI-based diagnosis with clinical implications?, Acta Neurol Scand, 117, pp. 409-414, (2008)
[3]  
Koch C.A., Doppman J.L., Watson J.C., Patronas N.J., Nieman L.K., Spinal epidural lipomatosis in a patient with ectopic ACTH syndrome, N Engl J Med, 341, pp. 1399-1400, (1999)
[4]  
Al-Khawaja D., Seex K., Eslick G.D., Spinal epidural lipomatosis: A brief review, J Clin Neurosci, 15, pp. 1323-1326, (2008)
[5]  
Kubina P., Gupta A., Oskarsson A., Axelsson K., Bengtsson M., Two cases of cauda equine syndrome following spinal-epidural anaesthesia, Reg Anesth, 22, pp. 447-450, (1997)
[6]  
Singh K., Samartzis D., Vaccaro A.R., Nassr A., Andersson G.B., Yoon S.T., Phillips F.M., Goldberg E.J., Howard S., Congenital lumbar spinal stenosis: A prospective, control-matched, cohort radiographic analysis, Spine J, 5, pp. 615-622, (2005)
[7]  
Reynolds F., Damage to the conus medullaris following spinal anaesthesia, Anaesthesia, 56, pp. 238-247, (2001)
[8]  
Broadbent C.R., Maxwell W.B., Ferrie R., Wilson D.J., Gawne-Cain M., Russell R., Ability of anaesthetists to identify a marked lumbar interspace, Anaesthesia, 55, 11, pp. 1122-1126, (2000)
[9]  
Shokei Y., Won D., Kido D.K., Adult tethered cord syndrome: New classification correlated with symptomatology, imaging and pathophysiology, Neurosurgery Quarterly, 11, pp. 260-275, (2001)
[10]  
Wu H.T., Scweitzer M.E., Parker L., Is epidural fat associated with body habitus?, J Comput Assist Tomogr, 29, pp. 99-102, (2005)