Midline spinous process splitting laminoplasty in a newborn with thoracolumbar epidural hematoma: a bone-sparing procedu
- PDF / 358,281 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 20 Downloads / 162 Views
CASE REPORT
Midline spinous process splitting laminoplasty in a newborn with thoracolumbar epidural hematoma: a bone-sparing procedure based on anatomy and embryology Antonio Tarabay 1 & Rodolfo Maduri 1 & Mattia Rizzi 2 & Juan Barges-Coll 3 & Anita C. Truttmann 4 & Mahmoud Messerer 1,3 Received: 5 August 2019 / Accepted: 3 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Spinal epidural hematoma (SEH) is a rare condition leading to spinal cord compression after trauma, surgery, or other. In 40% of the cases, the cause is unknown or unidentified. Due to the absence of specific symptoms, the diagnosis is often delayed. The mainstay of treatment is urgent evacuation of the hematoma. The choice of the surgical technique is surgeon-dependent and ranges from simple decompression and hematoma evacuation to variable combinations of decompression and reconstruction of the posterior spinal arch. To our knowledge, we describe the youngest case in the literature of a thoracolumbar SEH in a newborn with hemophilia A which was evacuated by spinous process splitting laminoplasty (SPSL). SPSL was chosen to avoid damaging the primary ossification centers, preserve the paravertebral musculature, and evade the sequelae of multilevel laminectomies. In our opinion, this technique should be propagated in the pediatric population for accessing the posterior and posterolateral spinal canal. Keywords Spinal . Epidural . Hematoma . Pediatrics
Introduction Spinal epidural hematoma (SEH) is a rare condition in children. The incidence in the general population is estimated at 0.1 patients per 100,000 per year [1–4] and is much less frequent in the pediatric population [2–5]. Multiple aetiologies for SEH are suggested in the literature such as spontaneous, traumatic, iatrogenic (including lumbar puncture and epidural anesthesia), hematologic disorders like lymphoma, leukemia and hemophilia, and vascular lesions (as arteriovenous * Mahmoud Messerer [email protected]
malformations, fistulas or hemangiomas) [5–10]. Most commonly SEH occur in the cervico-thoracic region and the hematoma is usually located dorsally to the spinal cord. The main initial symptom is pain, which as a very unspecific symptom often leads to delayed diagnosis, especially in younger children. Prompt diagnosis based on clinical examination and imaging is crucial in the presence of neurologic deficits because an early decompression can lead to excellent outcomes and recovery [5–12]. One of the most challenging situations is the decision process regarding the surgical 1
Service of Neurosurgery, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
2
Department of Woman-Mother-Child, Division of Pediatrics, Hematology/Oncology Unit, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
Mattia Rizzi [email protected]
3
Juan Barges-Coll [email protected]
Spine unit, Lausanne University Hospital and University of Lausanne, Rue
Data Loading...
