ABSTRACT
Abducens nerve palsy associated with spinal surgery is extremely rare. We report an extremely rare case of abducens nerve palsy after lumbar spinal fusion surgery with inadvertent dural tearing, which resolved spontaneously and completely. A 61-year-old previous healthy man presented with chronic lower back pain of 6 weeks duration and 2 weeks history of bilateral leg pain. He was diagnosed as having isthmic spondylolisthesis at L4-5 and L5-S1, and posterior lumbar interbody fusion was conducted on L4-5 and L5-S1. During the operation, inadvertent dural tearing occurred, which was repaired with a watertight dural closure. The patient recovered uneventfully from general anesthesia and his visual analogue pain scores decreased from 9 pre-op to 3 immediately after his operation. However, on day 2 he developed headache and nausea, which were severe when he was upright, but alleviated when supine. This led us to consider the possibility of cerebrospinal fluid leakage, and thus, he was restricted to bed. After an interval of bed rest, the severe headache disappeared, but four days after surgery he experienced diplopia during right gaze, which was caused by right-side palsy of the abducens nerve. Under conservative treatment, the diplopia gradually disappeared and was completely resolved at 5 weeks post-op.
ABSTRACT
BACKGROUND: The aim of this study is to compare the clinical outcomes and complications after targeted PTED and conventional microscopic diskectomy for removing 1-level unilateral LDH and to evaluate the efficacy of PTED for the treatment of LDH. METHODS: The authors retrospectively examined 915 consecutive patients who underwent PTED (group A, 301 patients) and microscopic diskectomy (group B, 614 patients) for 1-level unilateral LDH. Patients who were treated with a diskectomy in the period from July 2003 to December 2004 were evaluated by telephone interview and institute visit. This assessment was performed at least 18 months (range, 18-36 months) after their operation. The follow-up rate in groups A and B was 97.5% (295 patients) and 96.5% (607 patients), respectively. RESULTS: Good or excellent results were obtained in 84.7% and 85.0% of groups A and B (P = .92). The rates of recurrence were 6.44% and 6.75% in groups A and B (P > .05). Twenty-eight patients (14 cases of recurrence, 5 cases of incomplete removal, 5 cases of stenosis, 2 cases of diskogenic back pain, and 2 cases of diskitis) in group A and 38 patients (26 cases of recurrence, 6 cases of incomplete removal, 2 cases of stenosis, 2 cases of diskogenic back pain, 1 case of hematoma, and 1 case of diskitis) in group B underwent reoperation. CONCLUSIONS: Based on our results, the PTED can be a reasonable alternative to a conventional microscopic diskectomy for the treatment of patients with LDH, except for those in downward far-migrating cases beneath the pedicle of the lower vertebra or in cases involving L5-S1 with a high pelvis.
