From the Guidelines
Post-laminectomy myelitis is the type of myelitis that can be triggered after a laminectomy procedure. This condition is an inflammation of the spinal cord that can occur as a rare complication following spinal surgery, particularly laminectomy, and is often associated with extrinsic compression of the spinal cord, which can develop throughout the postoperative course and may be secondary to seromas, pseudomeningoceles, hematomas, and/or epidural abscesses 1. Symptoms may include progressive weakness, sensory changes, and bowel/bladder dysfunction.
The exact cause of post-laminectomy myelitis is not fully understood, but it's thought to be related to:
- Direct trauma to the spinal cord during surgery
- Ischemia (reduced blood flow) to the spinal cord
- An autoimmune response triggered by the surgical intervention These factors can contribute to the development of myelopathy, which can be acute or progressive, and may be caused by various conditions, including degenerative disease, vertebral fracture, and infection 1.
If suspected, immediate medical attention is crucial, and treatment typically involves:
- High-dose intravenous corticosteroids
- Supportive care and rehabilitation
- In some cases, plasma exchange or intravenous immunoglobulin may be considered Prevention focuses on careful surgical technique and minimizing spinal cord manipulation during the procedure, as well as monitoring patients closely post-surgery for any signs of neurological deterioration 1. Understanding this potential complication is important for both surgeons and patients to ensure prompt recognition and treatment if it occurs after a laminectomy.
From the Research
Types of Myelitis Triggered After Laminectomy
- Transverse myelitis can be triggered after a laminectomy procedure, as reported in several studies 2, 3, 4, 5.
- The exact pathogenic relationship between laminectomy and myelitis is not fully understood, but it is believed to be related to various factors such as autoimmune disorders, spinal cord ischemia, and parainfectious sequelae 3, 5.
- Longitudinally extensive transverse myelitis (LETM) is a specific type of myelitis that can occur after laminectomy, characterized by a long-segment hyperintense signal on T2-weighted MRI 2.
- Recurrent transverse myelitis can also occur after laminectomy, highlighting the importance of swift and aggressive diagnostic and treatment intervention 5.
Clinical Presentation and Diagnosis
- Patients with myelitis triggered after laminectomy may present with acute neurologic deficits, including paraplegia, sensory alterations, and bowel incontinence 2, 3, 5.
- Magnetic resonance imaging (MRI) is a crucial diagnostic tool for identifying myelitis, showing intramedullary hyperintensity lesions on T2-weighted imaging 2, 3, 6.
- High-dose corticosteroid therapy is often used as a treatment for myelitis, with variable success rates 2, 3, 6.
Prognosis and Management
- The prognosis for patients with myelitis triggered after laminectomy is variable, ranging from partial recovery to severe neurologic residua 2, 3, 5.
- Early identification and treatment of myelitis are critical to minimizing neurologic sequelae 3, 6.
- Immunosuppressant therapies may be used to stabilize patients with recurrent myelitis and prevent further episodes 5.