Nonhemorrhagic cord contusion after percutaneous fiducial placement: case report and surgical recommendations.
METHODS
Single case report and extensive literature review.


OBJECTIVE
To present the first such report of cervical cord contusion after the percutaneous placement of gold-seed fiducials. The pathomechanics and surgical recommendations are reviewed.


BACKGROUND
Spinal cord injuries are well documented in the medical literature. These injuries range from cord contusion to transection and result primarily from trauma. A single case report of a patient who was found to have a nonhemorrhagic cervical spinal cord contusion after percutaneous fiducial implantation is presented.


METHODS
Single case report.


RESULTS
The patient underwent percutaneous placement of fiducials for stereotactic radiosurgery for a nerve sheath tumor. Postoperatively she had primarily sensory complaints; no motor deficits were detected on neurological examination. Neuroimaging studies demonstrated nonhemorrhagic cervical cord contusion. She was treated conservatively and had complete resolution of her symptoms.


CONCLUSIONS
The likely mechanism for the contusion was neck hyperextension during thrusting maneuvers during fiducial implantation. This is yet another report of normal intraoperative-evoked potentials with postoperative neurological sequelae. A dedicated team approach involving ancillary staff, anesthesiologists, and surgeons should be utilized to avert this potentially devastating complication.
Stevens
Quails E
QE
Bromenn Regional Medical Center, Department of Surgery, Section of Neurosurgery, Normal, Illinois, USA. qspine@yahoo.com
Dickerman
Rob D
RD
Kattner
Keith A
KA
Stroink
Ann R
AR
D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D008875:Middle Aged; D018317:Nerve Sheath Neoplasms / Q000601:surgery; D016634:Radiosurgery / Q000009:adverse effects* / Q000295:instrumentation*; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013120:Spinal Cord Neoplasms / Q000601:surgery