title: Pneumocephalus: An unusual complication of lumbar arthrodesis. A clinical case and literature review.
abstract: Pneumocephalus is an uncommon but serious complication of spinal surgery and its management and pathophysiology is not widely recognized. The incidence of symptomatic tension pneumocephalus secondary to posterior spinal arthrodesis is unknown.
  
  
  METHODS
  The case is reported of a rare case of a 41 year old woman with diagnosis of L3-L4, L4-L5 disc disease and left disc herniation L4-L5. A posterior spinal arthrodesis L3-L5, L3-L4 and L4-L5 discectomies and release of the left L5 root, was performed without apparent complications. Twenty-four hours after surgery the patient developed generalized headache, neck stiffness, and dysarthria. MRI and CT scans revealed a huge pneumocephalus in the subarachnoid space, predominantly in the left frontal lobe without midline shift, which originated in the lumbar spinal canal. The patient was treated conservatively, with progressive neurological improvement after 72 hours, and clinical and radiological normalization after 7 days.
  
  
  CONCLUSIONS
  Pneumocephalus is a rare but potentially serious complication of spine surgery related in most cases with inadvertent dural tear during the operation. Most collections are small, behave benign, and respond to conservative therapy. In the present case, an inadvertent dural tear, produced a pneumocephalus. A high degree of suspicion is needed to make the diagnosis, prompt treatment, as well as remedying the source of air to prevent unwanted morbidity and mortality.
authors.affiliation: Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España. Electronic address: candarciab@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Andarcia-Bañuelos
authors.affiliation: Cirugía Ortopédica, Unidad de Cirugía de Columna, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
authors.forename: P
authors.initials: P
authors.lastname: Cortés-García
authors.affiliation: Cirugía Ortopédica, Unidad de Cirugía de Pie y Tobillo, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
authors.forename: M U
authors.initials: MU
authors.lastname: Herrera-Pérez
authors.affiliation: Cirugía Ortopédica, Unidad de Cirugía de Columna, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
authors.forename: B
authors.initials: B
authors.lastname: Deniz-Rodríguez
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D011007:Pneumocephalus / Q000000981:diagnostic imaging / Q000209:etiology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed
keywords: Artrodesis lumbar posterior; Complicación posquirúrgica; Dural tear; Lesión dural; Neumoencéfalo; Pneumocephalus; Post-surgical complication; Posterior lumbar arthrodesis