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AAP Annual Meeting Abstracts: Abstracts of Scientific Papers and Posters Presented at the Annual Meeting of the Association of Academic Physiatrists: Daytona Beach, Florida March 2-4, 2006: POSTER BOARD PRESENTATIONS: Friday, March 3, 2006

POSTER BOARD F22: BROWN-SEQUARD SYNDROME AFTER CERVICAL SPINE LAMINECTOMY AND FUSION: A CASE REPORT

Agarwal, Sanjeev MD; Gaudino, Walter MD; Isaacson, Adam MD; Weiss, Lyn MD

American Journal of Physical Medicine & Rehabilitation: March 2006 - Volume 85 - Issue 3 - p 270
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Setting:

Inpatient rehabilitation unit

Patient:

48 yr old female.

Case Description:

The patient with no significant PMH developed progressive lower extremity weakness, difficulty in ambulation and numbness. MRI/CT scan revealed ossification of posterior longitudinal ligament at C2-C5 and C2-6 disc herniation with marked cord compression, cord malacia and atrophy at C2-C4. In view of myelopathic signs and symptoms, patient underwent an elective C1-C7 cervical decompression/laminectomy with in situ fusion. On same postoperative day patient developed right-sided hemiplegia with allodynia and left sided sensory impairment. Postoperative work up included a negative CT scan for stroke. Cervical spine MRI showed stenosis relief and questionable spinal cord edema at C2-C3. There was no neurological improvement after intravenous solumedrol. Patient made gradual recovery after inpatient rehabilitation.

Discussion:

Brown-Sequard syndrome is an incomplete spinal cord lesion characterized by a clinical picture reflecting hemisection of the spinal cord in the cervical or thoracic region and most frequently seen in association with trauma, spinal tumors, spinal vascular diseases, myelitis and rarely cervical disc herniation. The pathophysiology is damage or loss of ascending and descending spinal cord tracts on one side of the spinal cord. MRI scan is the diagnostic modality of choice and can determine the exact structures damaged as well as nontraumatic etiologies. Neurologic deficits have been reported after spine surgery, especially after corrective surgery for spinal deformity. The potential etiologies include a vascular insult, compression either by epidural hematoma or implants, infolding of ligamentum flavum, posterior longitudinal ligament or disc material. The distraction of spinal cord with instrumentation in corrective surgery may also be responsible.

Conclusions:

Spinal cord injuries are catastrophic events with devastating medical and personal effects. Incomplete spinal cord injuries, younger patients, and patients with central cord or Brown-Sequard syndrome have a more favorable prognosis for recovery.

© 2006 Lippincott Williams & Wilkins, Inc.