TY - JOUR
T1 - Retroperitoneal approach for the treatment of diaphragmatic crus syndrome
T2 - technical note
AU - Pennington, Zach
AU - Jiang, Bowen
AU - Westbroek, Erick M.
AU - Cottrill, Ethan
AU - Greenberg, Benjamin
AU - Gailloud, Philippe
AU - Wolinsky, Jean Paul
AU - Lum, Ying Wei
AU - Theodore, Nicholas
N1 - Publisher Copyright:
© AANS 2020.
PY - 2020/7
Y1 - 2020/7
N2 - OBJECTIVE Myelopathy selectively involving the lower extremities can occur secondary to spondylotic changes, tumor, vascular malformations, or thoracolumbar cord ischemia. Vascular causes of myelopathy are rarely described. An uncommon etiology within this category is diaphragmatic crus syndrome, in which compression of an intersegmental artery supplying the cord leads to myelopathy. The authors present the operative technique for treating this syndrome, describing their experience with 3 patients treated for acute-onset lower-extremity myelopathy secondary to hypoperfusion of the anterior spinal artery. METHODS All patients had compression of a lumbar intersegmental artery supplying the cord; the compression was caused by the diaphragmatic crus. Compression of the intersegmental artery was probably producing the patients’ symptoms by decreasing blood flow through the artery of Adamkiewicz, causing lumbosacral ischemia. RESULTS All patients underwent surgery to transect the offending diaphragmatic crus. Each patient experienced substantial symptom improvement, and 2 patients made a full neurological recovery before discharge. CONCLUSIONS Diaphragmatic crus syndrome is a rare or under-recognized cause of ischemic myelopathy. Patients present with episodic acute-on-chronic lower-extremity paraparesis, gait instability, and numbness. Angiography confirms compression of an intersegmental artery that gives rise to a dominant radiculomedullary artery. Transecting the offending diaphragmatic crus can produce complete resolution of neurological symptoms.
AB - OBJECTIVE Myelopathy selectively involving the lower extremities can occur secondary to spondylotic changes, tumor, vascular malformations, or thoracolumbar cord ischemia. Vascular causes of myelopathy are rarely described. An uncommon etiology within this category is diaphragmatic crus syndrome, in which compression of an intersegmental artery supplying the cord leads to myelopathy. The authors present the operative technique for treating this syndrome, describing their experience with 3 patients treated for acute-onset lower-extremity myelopathy secondary to hypoperfusion of the anterior spinal artery. METHODS All patients had compression of a lumbar intersegmental artery supplying the cord; the compression was caused by the diaphragmatic crus. Compression of the intersegmental artery was probably producing the patients’ symptoms by decreasing blood flow through the artery of Adamkiewicz, causing lumbosacral ischemia. RESULTS All patients underwent surgery to transect the offending diaphragmatic crus. Each patient experienced substantial symptom improvement, and 2 patients made a full neurological recovery before discharge. CONCLUSIONS Diaphragmatic crus syndrome is a rare or under-recognized cause of ischemic myelopathy. Patients present with episodic acute-on-chronic lower-extremity paraparesis, gait instability, and numbness. Angiography confirms compression of an intersegmental artery that gives rise to a dominant radiculomedullary artery. Transecting the offending diaphragmatic crus can produce complete resolution of neurological symptoms.
KW - Anterior spinal artery syndrome
KW - Artery of Adamkiewicz
KW - Diaphragmatic crus syndrome
KW - Surgical technique
KW - Vascular myelopathy
KW - Ventral cord syndrome
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U2 - 10.3171/2020.1.SPINE191455
DO - 10.3171/2020.1.SPINE191455
M3 - Article
C2 - 32197244
AN - SCOPUS:85088416264
SN - 1547-5654
VL - 33
SP - 114
EP - 119
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 1
ER -