[Posterior extrusion of Biocompatible Orthopaedic Polymer (BOP) graft mimicking a calcified lumbar disc herniation: case report].
OBJECTIVE
We present a case of intracanalar extrusion of a L5S1 Biocompatible Orthopaedic Polymer (BOP) graft associated with a L4L5 disc herniation 19 years after a lumbar intersomatic fusion for a L5S1 disc herniation. Radiological aspect of this complication should be recognized by neurosurgeons.


METHODS
A 55-year old man presented with a right L5 sciatic pain. Neurological examination found a severe weakness in dorsal flexion of the foot. A lumbar CT scanner disclosed aspects consistent with right L4L5 and huge calcified L5S1 lumbar disc herniation.


METHODS
The patient was operated via a bilateral paravertebral approach and a L5 laminectomy. A dense and extensive epidural scarring was seen. The right L4L5 herniated disc was excised. At the left L5S1 level, fibres from a BOP graft had separated into large fragments extruded into the vertebral canal through the dura. The fibres could only be removed partially because of nerve roots adherence. The patient developed postoperative cerebrospinal fluid (CSF) leakage that required a second operation for dural closure. The postoperative course was uneventful and the patient recovered the right L5 root deficit.


CONCLUSIONS
Neurosurgeons should be aware of the radiological aspect of this complication. If it is recognized on CT scan and asymptomatic, conservative management should be proposed because of the risk of nerve roots injury or postoperative CSF leakage.
Thines
L
L
Clinique neurochirurgicale, hôpital Roger-Salengro, CHRU, 59037 Lille cedex, France. laurent.thines@wanadoo.fr
Allaoui
M
M
Assaker
R
R
D001672:Biocompatible Materials / Q000009:adverse effects*; D018786:Bone Substitutes / Q000009:adverse effects*; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging*; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000134:cerebrospinal fluid / Q000601:surgery; D012585:Sciatica / Q000209:etiology; D013123:Spinal Fusion; D013126:Spinal Nerve Roots / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
D001672:Biocompatible Materials; D018786:Bone Substitutes