A Case of Basal Ganglia Intraparenchymal Hemorrhage Following Lumbar Spinal Surgery.

We report on a rare case of basal ganglia intraparenchymal hemorrhage with intraventricular extension occurring after a lumbar spinal surgery. A 65-year-old female presented for an elective L4-L5 lumbar laminectomy and posterior spinal fixation. Her initial operation was complicated by a cerebrospinal fluid (CSF) leak repaired with a dural synthetic graft. Her immediate post-operative course was complicated by delayed emergence, eye-opening apraxia, and left-sided hemiplegia and subsequent computed tomography (CT) of the head demonstrated a right-sided basal ganglia intraparenchymal hemorrhage (IPH) with intraventricular extension. CT angiogram of the head was unremarkable. She was taken back to the operating room for right-sided decompressive hemicraniectomy and external ventricular drainage (EVD) for hydrocephalus. Her EVD was discontinued on post-bleed day 13 and she was discharged on post-bleed day 14 to a long-term care facility with a modified Rankin scale (mRS) score of 6. She returned for a cranioplasty six months later, and on her last follow-up at nine months, had a mRS of 4 with persistent confusion and severe left-sided hemiparesis but was able to form simple sentences. In summary, intracranial hemorrhage is a rare complication of spine surgery, occurring in a small percentage of the population. Lobar IPH following spinal surgery is a rare complication, and has been hypothesized to be a result of excessive CSF loss during durotomy.

Delayed Anterior Cervical Screw Migration Causing Swallowing Difficulty.

Cervical disc disease is a common pathology that may require surgical intervention. A common surgical intervention for cervical disc disease is anterior discectomy and fusion. A number of complications are associated with this technique, including hoarseness, dysphagia, pseudoarthrosis, adjacent segment disease, and hardware failure. Here, we present a case detailing a unique complication of delayed migration of an anterior cervical screw which resulted in swallowing difficulties. Subsequently, we discuss the related reports and highlight the literature on the topic. We conclude with a brief discussion on the principle of patient autonomy.