Retroperitoneal approach for the treatment of diaphragmatic crus syndrome: technical note

Zach Pennington, Bowen Jiang, Erick M. Westbroek, Ethan Cottrill, Benjamin Greenberg, Philippe Gailloud, Jean Paul Wolinsky, Ying Wei Lum, Nicholas Theodore

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)114-119
Number of pages6
JournalJournal of Neurosurgery: Spine
Volume33
Issue number1
DOIs
StatePublished - Jul 2020

Keywords

  • Anterior spinal artery syndrome
  • Artery of Adamkiewicz
  • Diaphragmatic crus syndrome
  • Surgical technique
  • Vascular myelopathy
  • Ventral cord syndrome

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

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  • Cite this

    Pennington, Z., Jiang, B., Westbroek, E. M., Cottrill, E., Greenberg, B., Gailloud, P., Wolinsky, J. P., Lum, Y. W., & Theodore, N. (2020). Retroperitoneal approach for the treatment of diaphragmatic crus syndrome: technical note. Journal of Neurosurgery: Spine, 33(1), 114-119. https://doi.org/10.3171/2020.1.SPINE191455