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. 2006;29(4):425-9.
doi: 10.1080/10790268.2006.11753892.

Nonhemorrhagic Cord Contusion After Percutaneous Fiducial Placement: Case Report and Surgical Recommendations

Free PMC article

Nonhemorrhagic Cord Contusion After Percutaneous Fiducial Placement: Case Report and Surgical Recommendations

Quails E Stevens et al. J Spinal Cord Med. .
Free PMC article


Study design: Single case report and extensive literature review.

Objectives: To present the first such report of cervical cord contusion after the percutaneous placement of gold-seed fiducials. The pathomechanics and surgical recommendations are reviewed.

Background: Spinal cord injuries are well documented in the medical literature. These injuries range from cord contusion to transection and result primarily from trauma. A single case report of a patient who was found to have a nonhemorrhagic cervical spinal cord contusion after percutaneous fiducial implantation is presented.

Methods: Single case report.

Results: The patient underwent percutaneous placement of fiducials for stereotactic radiosurgery for a nerve sheath tumor. Postoperatively she had primarily sensory complaints; no motor deficits were detected on neurological examination. Neuroimaging studies demonstrated nonhemorrhagic cervical cord contusion. She was treated conservatively and had complete resolution of her symptoms.

Conclusions: The likely mechanism for the contusion was neck hyperextension during thrusting maneuvers during fiducial implantation. This is yet another report of normal intraoperative-evoked potentials with postoperative neurological sequelae. A dedicated team approach involving ancillary staff, anesthesiologists, and surgeons should be utilized to avert this potentially devastating complication.


Figure 1
Figure 1. (A) Sagittal T2-weighted preoperative image without any visible lesions in the cord substance. (B) Sagittal T1-weighted postgadolinium image demonstrates the foraminal expansion by the neural sheath lesion (arrow). There is marked enhancement of the lesion. (C) Axial T2-weighted image shows the isointense-to heterogenous-appearing lesion. Again, the lesion enhances vividly after contrast administration.
Figure 2
Figure 2. (A) Sagittal T2-weighted image demonstrates the focus of hyperintensity at the level of the C6-C7 disk interspace. Note also the disk bulge/degeneration at the C5-C6 and C6-C7 levels. (B) Axial T2-weighted image demarcates the hyperintense focus of the contusion. There is not any significant expansion of the spinal cord substance. (C) Axial computerized tomography image at the level of the C6-C7 levels demonstrates the implanted fiducial at the spinolaminar junction on the left. The fiducial is contained and does not breach the anterior cortex.
Figure 3
Figure 3. Sagittal T2-weighted scan shows marked diminution in the size of the nonhemorrhagic contusion (arrowhead). Note the C5-C6 disk abuts, but does not efface, the thecal sac.

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