Brown-Sequard syndrome caused by posterior full-endoscopic cervical discectomy: A case report

Abstract

Background: Posterior full-endoscopic cervical discectomy (PFECD) is an effective and safe technique for cervical radiculopathy. The primary complications of PFECD include temporary nerve root paralysis and dural rupture, while spinal cord damage is exceedingly rare. This study describes a rare case of Brown-Sequard syndrome (BSS) occurring following PFECD and investigates its potential etiologies and pathomechanisms associated with this procedure.

Methods: Notes and images were reviewed and the relevant literature was analyzed.

Results: A 50-year-old woman underwent PFECD for cervical radiculopathy. The patient reported substantial alleviation of radicular pain symptoms on the first postoperative day. On the third postoperative day, the patient exhibited acute-onset weakness in the left lower limb, along with diminished pinprick and temperature sensation in the right limb. Cervical spine magnetic resonance imaging demonstrated a newly developed T2 hyperintensity at the C5 spinal cord level. BSS was confirmed based on correlating imaging findings with clinical signs. Following the comprehensive treatment of rehabilitation and pharmacological therapy, the patient's neurological deficits symptoms gradually improvement. At the 6-month follow-up, the patient's symptoms resolved entirely, and the T2 hypersignal diminished markedly on repeat magnetic resonance imaging.

Conclusion: This study represents the first case of BSS following PFECD. We emphasize that although the PFECD technique is safe and effective, meticulous surgical technique-particularly in foraminal decompression-is critical to avoid iatrogenic spinal cord injury.

Keywords: Brown; Sequard syndrome; endoscopic cervical discectomy; posterior full; spinal cord injury.

Figure 1.

Preoperative T2W1 MRI imaging of the patient’s sagittal (A) and axial (B) reveals left-sided foraminal stenosis and the C5–C6 intervertebral disc herniation to the left rear. The preoperative CT examination (C, D) indicated stenosis of the 5 to 6 cervical foramen with uncovertebral joint hyperplasia. CT = computerized tomography, MRI = magnetic resonance imaging.

Figure 2.

The K-wire was inserted through the safe operating area and anchored into the objective articular process, and serial dilators and endoscopic were established (A, B). Endoscopic radiofrequency electrocoagulation for hemostasis (C). The nerve root was completely decompressed (D). The sagittal view of CT (E) and three-dimensional reconstruction (F) demonstrate the enlargement of the intervertebral foramen. CT = computerized tomography.

Figure 3.

The patient underwent an MRI on the third postoperative day. Sagittal MRI images (A, T2W1; B, T2W1 STIR) revealed an abnormal T2 hyperintensity in the spinal cord at the cervical 5 vertebra level. The T2W1 STIR axial MRI (C) of the spinal cord revealed the aberrant signal bias to the left. MRI imaging at 6 months post-surgery. The T2 hyperintensity of the spinal cord at the level of the cervical 5 vertebrae was much lower than it had been before, as shown by sagittal MRI images (D, T2W1; E, T2W1 STIR) and axial MRI (F, T2W1 STIR). MRI = magnetic resonance imaging.