Motor Weakness of Right Ankle Dorsiflexion Caused by Increasing Size of Sacroiliac Joint Cyst after Posterior Lumbar Interbody Fusion in a Patient with Spinal Stenosis - A Case Report -

Ji-Eun Kwon; Young-Joon Ahn; Bo-Kyu Yang; Seung-Rim Yi; Se-Hyuk Lim; Ye-Hyun Lee; Hae-Min Kim

doi:10.4184/jkss.2015.22.4.178

Journal List > J Korean Soc Spine Surg > v.22(4) > 1076067

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kwon, Ahn, Yang, Yi, Lim, Lee, and Kim: Motor Weakness of Right Ankle Dorsiflexion Caused by Increasing Size of Sacroiliac Joint Cyst after Posterior Lumbar Interbody Fusion in a Patient with Spinal Stenosis - A Case Report -

Case Report

Journal of Korean Spine Surg 2015;22(4):178-182.

Published online: 21 December 2015

DOI: https://doi.org/10.4184/jkss.2015.22.4.178

Motor Weakness of Right Ankle Dorsiflexion Caused by Increasing Size of Sacroiliac Joint Cyst after Posterior Lumbar Interbody Fusion in a Patient with Spinal Stenosis - A Case Report -

Ji-Eun Kwon, M.D., Young-Joon Ahn, M.D., Bo-Kyu Yang, M.D., Seung-Rim Yi, M.D., Se-Hyuk Lim, M.D., Ye-Hyun Lee, M.D., Hae-Min Kim, M.D.

Department of Orthopeadic Surgery, National Police Hospital, Seoul, Korea

Corresponding author: Young-Joon Ahn, M.D. 123, Songi-ro, Songpa-gu, Seoul, 138-708 National Police Hospital TEL: +82-2-3400-1252, FAX: +82-2-449-2120 E-mail: osahnyj@lycos.co.kr

Received 22 July 201518 August 2015 Accepted 20 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Case report

Objectives

To report a case of motor weakness caused by the increasing size of a sacroiliac joint cyst after spinal fusion.

Summary of Literature Review

There have been no reports on the increased size of a sacroiliac joint cyst and motor weakness after spinal fusion.

Materials and Methods

A 63-year-old female was admitted with low back pain and right sciatica. Magnetic resonance imaging (MRI) findings showed the spinal canal narrowing at L4–5 and a cystic lesion on the right sacroiliac joint. After surgery, the symptoms were relieved.

Results

One month after the operation, motor function had worsened to grade 4. Followup MRI revealed an increase in the size of the cystic lesion. Selective nerve root blocks were performed. There was gradual improvement, and the motor grade reached grade 5 seven months after the operation.

Conclusions

We recommend that surgeons evaluate the adjacent segmental lesion by MRI before performing spinal fusion.

Keywords: Sacroiliac joint, Cyst, Muscle weakness, Spinal stenosis, Spinal fusion

REFERENCES

1. Ha KY, Kim YH, Kang KS. Surgery for Adjacent Segment Changes after Lumbosacral Fusion. J Korean Soc Spine Surg. 2002; 9:332–40.

2. Hwang CJ, Lee SW, Ahn YJ, et al. Risk Factors for Adjacent Segment Disease After Lumbar Fusion. J Korean Soc Spine Surg. 2008; 15:44–53.

3. Bastian L, Lange U, Knop C, et al. Evaluation of The Mobility of Adjacent Segments after Posterior Thoracolumbar Fixation: A Biomechanical Study. Eur Spine J. 2001; 10:295–300.

4. Park P, Garton HJ, Gala VC, et al. Adjacent Segment Disease after Lumbar or Lumbosacral Fusion: Review of the Literature. Spine (Phila Pa 1976). 2004; 29:1938–44.

5. Ha KY, Lee JS, Kim KW. Degeneration of Sacroiliac Joint After Instrumented Lumbar or Lumbosacral Fusion: A Prospective Cohort Study over Five-Year Followup. Spine (Phila Pa 1976). 2008; 33:1192–8.

6. Kikuchi S, Konno S, Kayama S, et al. Increased Resistance to Acute Compression Injury in Chronically Compressed Spinal Nerve Roots: An Experimental Study. Spine (Phila Pa 1976). 1996; 21:2544–50.

Fig. 1.

Initial magnetic resonance imaging (MRI) reveals spinal stenosis at L4–5 in the sagittal (A) and the axial (B) images, and a cystic lesion measuring 1.6 cm×1.0 cm at the inferior surface of the right sacroiliac joint in the coronal (C) image.

Fig. 2.

Posterior decompression and posterior lumbar interbody fusion with a cage was performed at L4–5 (A, B).

Fig. 3.

Followup MRI revealed the increased size of the cystic lesion measuring 3.3 cm×2.2 cm×1.6 cm in coronal (A) and axial (B) images (inferior and ventral aspects of the sacroiliac joint, S2–3 level).

Fig. 4.

Followup MRI taken after three years of the operation showed a further increase in the lesion size to 4.9 cm×2.6 cm×1.8 cm in the coronal (A) and axial (B) images.

TOOLS

Similar articles