324 - Lumbosacral Myelopathy Secondary to Pseudomeningocele

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

ER

Erick Rosenvall, MD

Resident
ECU Health Medical Center
Greenville, North Carolina, United States

Co-Author(s)

DM

Daniel Moore, MD

Professor emeritus
Is east carolina university
Greenville, North Carolina, United States
AP

Anand J. Pooleri, MD

Resident
ECU Health
Greenville, North Carolina, United States

Presenter(s)

CC

Cole Carter, DO

Resident
ECU Health Medical Center
Greenville, North Carolina, United States

Case Diagnosis: 76-year-old female with lumbosacral myelopathy due to pseudomeningocele resistant to arachnoid cyst fenestration

Case Description: An electrodiagnostic study was performed due to bilateral lower extremity weakness. Neurosurgical history included lumbar fusions, drainage of a symptomatic pseudomeningocele, and recently T12-L12 laminectomies with arachnoid fenestration. There was recurrence of right lower extremity weakness as well as bladder and bowel dysfunction. Lumbar spine MRI revealed an expanding thoraco-lumbar pseudomeningocele with mass effect on cord and roots. Right lower extremity demonstrated decreased calf muscle bulk, decreased hip flexion, knee flexion and extension, and foot drop. Sensation was decreased in the superficial and deep fibular dermatomes with intact plantar surface sensation. Left lower extremity was unaffected. Nerve conduction studies revealed a right lower extremity axonal motor polyneuropathy affecting the tibial and fibular nerves. Electromyography exhibited active and chronic denervation of the bilateral L2-S2 nerve roots. Reconciling the patients prior imaging with the electrodiagnostic study, findings were consistent with a thoracolumbar myelopathy affecting the lumbosacral nerve roots.

Discussions: Myelopathy is an injury to the spinal cord caused by severe cord compression. Symptoms include pain, paresthesia, imbalance, abnormal reflexes, and bowel/bladder dysfunction. Symptoms manifest at or below the level of injury and can lead to permanent nerve damage or spinal cord injury. Myelopathy can occur at any spinal level, however lumbosacral myelopathy is rare. Diagnosis includes spine x-ray, MRI or CT, and myelography. Electrodiagnostic studies are vital for the workup of lumbosacral myelopathy as it can determine the location of involvement and effects on the peripheral nervous system, ruling out a radiculopathy or mononeuropathy. This can aid in timing and aggressiveness of interventional treatment options.

Conclusions: While lumbosacral myelopathy is uncommon, it is important to understand the role of electrodiagnostic studies in patients with lumbosacral pathology such as a pseudomeningocele. Prompt diagnosis can ensure proper treatment and avoidance of permanent damage.