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CT-guided percutaneous aspiration of the subdural fluid collection after lumbar surgery 2011

Interventional Spine

Hyung-Seok, Kim, M.D.
Jin-Hee, Park, M.D., Non ASSR Member
Pyung-Jin, Kim, M.D., Non ASSR Member
Ji-Youn, Yu, M.D., Non ASSR Member
Sang-Ho, Lee, M.D., Non ASSR Member

Excerpta

Subdural fluid collection after the lumbar spinal surgery is a rare complication. Subdural space in the spine is not a potential space since the creation of a cleft in this area of the meninges is the result of tissue damage.

Purpose

To introduce the clinical symptom, MR findings and the CT-guided percutaneous aspiration of a patient of subdural fluid collection after lumbar fusion surgery.

Methods & Materials

A 70-year-old female patient with severe radiating leg pain ten days after the lumbar fusion surgery. The MR images on 13 days after the operation showed posterior intradural fluid collection from T-L junction to S2 level with ventral shifting of the conus medullaris and nerve roots. Axial images demonstrated lobulating biconcave fluid collection in the subdural space not subarchonid or epidural spaces. We performed percutaneous aspiration under the CT-guidance.

Results

We aspirated about 14 cc thin bloody colored fluid at L3 and L5 level under the CT-guidance technique. The MR images after the aspiration demonstrated decreased intradural fluid and dorsal shifting of the conus medullaris and the roots. The patient's symptom was partially improved immediately, and more improved gradually. There was no growth of the organism in the aspirated fluid.

Conclusion

The subdural fluid collection in the spine is a rare complication after the lumbar surgery. But it could induce severe pain of the patient. CT-guided percutaneous aspiration is the good method of the treatment of the subdural fluid collection.

References/Financial Disclosures

1. On the Question of a Subdural space. D.E.Haines. The Anatomical Record 1991;230:3-21 2. Acute Spinal Subdural Hematoma: MR and CT Findings with Pathologic Correlates. M.Judith Donovan Post, Jose L.Becerra, Parley W. Madsen et al. AJNR 1994;15:1895-1905 3. Traumatic Spinal Subdural Hematoma with Spontaneous Resolution. KS Hung, CC Liu, CH Wang et al. Spine 2002;27:E534-538 4. Acute Nontraumatic Spinal Subdural Hematomas in Three Patients.X Morandi,L Riffaud, E Chabert, G Brassier. Spine 2001;26:E547-551 5. The Importance of MRI Findings for the Diagnosis of Nontraumatic Lumbar Subacute Subdural Hematomas. PJ Johnson, HJ McConnnel, EG Graham, LG Leibrock. Acta Neurochirurgica 1991;113:186-188

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