Dural Laceration Resulting in the Formation of Syringomyelia Caused by a Loosened Hydroxyapatite Intraspinous Spacer after Spinous Process-splitting Laminoplasty

Abstract

A 63-year-old man was admitted in our hospital with the chief complaint of upper limb numbness 3 years after undergoing spinous process-splitting laminoplasty (C3–C7) in another hospital. The hydroxyapatite spacers used for the laminoplasty had dislocated, resulting sensory disorders of the upper extremities. Additionally, loosened hydroxyapatite intraspinous spacers and syringomyelia were confirmed. A revision operation was performed, during which the C5 spacer was observed to have dislodged into the spinal canal, and a dural membrane defect, arachnoid membrane tear, cerebrospinal fluid leakage, and marked adhesion change were observed. The adhesion was exfoliated as far as possible; moreover, to prevent the reflux of syringomyelia, a syrinx-subarachnoid shunt (SS shunt) was placed. Although there was concern of further adhesion by putting foreign matter, SS shunt indwelling was chosen to obtain sure disappearance of syringomyelia. The postoperative course was uneventful. A gradual improvement in the upper limb numbness was observed without a recurrence of syringomyelia at 9 years of follow-up.