Post-operative Lumbar Pseudomeningeocele: Management and Evaluation

lumbar pseudomeningeocele is considered as an uncommon complication of spinal surgery. Studiesconcerned with this complex formation are still few. Objectives: the aim of the present study was to evaluate the clinical results of treating post-operative lumbar pseudo-meningeocele. Risk factors for the formation of pseudomeningeocele were also discussed. Patients and Methods: this is a retrospective study done on 12 patients who developed symptomatic lumbar pseudo-meningeocele after various spinal surgeries between 2000 and 2011. All patients were operated upon in Ain Shams University Hospitals (Cairo, Egypt). All patients who developed post-operative pseudomeningeocele were studied clinically and radiologically (Magnetic Resonance Imaging MRI, Computed Tomography CT, X-ray of lumbosacral region) to assess the pseudo-meningeocele and the neurological status before and after any procedure. All patients had a cerebrospinal fluid diversion by lumbar drainage. Three cases had satisfactory results, one patient needed a percutenous evacuation, and eight cases needed surgical repair. Results: 12 patients (7 males and 5 females) with post-operative lumbar pseudomeningeocele, were included in this study. Eight patients had surgical repair. Follow up ranged from (6 to 24) months with a mean follow up of (17.4) months. The clinical state of the patients preoperatively was: back pain (58.3%), headache (25%), nausea/vomiting (16.6%) and limb pain/numbness (33.3%). Clinical outcome as described by Wang35 revealed excellent in 10 patients and good in 2 patients. Conclusion: Iatrogenic pseudomeningeocele is a rare complication of spinal surgery and should be suspected in patients submitted to lumbar surgery when delayed post operative neurological symptoms occur.