• Kang Lu, Hao-Kuang Wang, Po-Chou Liliang, Chih-Hui Yang, Cheng-Yo Yen, Yu-Duan Tsai, Po-Yuan Chen, Cien-Leong Chye, Kuo-Wei Wang, Cheng-Loong Liang, and Han-Jung Chen.
• Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. Electronic address: kanglu.1002@gmail.com.
• World Neurosurg. 2017 Sep 1; 105: 824-831.

ObjectiveWhen a cervical or thoracic benign intradural spinal tumor (BIST) coexists with lumbar degenerative diseases (LDD), diagnosis can be difficult. Symptoms of BIST-myelopathy can be mistaken as being related to LDD. Worse, an unnecessary lumbar surgery could be performed. This study was conducted to analyze cases in which an erroneous lumbar surgery was undertaken in the wake of failure to identify BIST-associated myelopathy.MethodsCases were found in a hospital database. Patients who underwent surgery for LDD first and then another surgery for BIST removal within a short interval were studied. Issues investigated included why the BISTs were missed, how they were found later, and how the patients reacted to the unnecessary lumbar procedures.ResultsOver 10 years, 167 patients received both surgeries for LDD and a cervical or thoracic BIST. In 7 patients, lumbar surgery preceded tumor removal by a short interval. Mistakes shared by the physicians included failure to detect myelopathy and a BIST, and a hasty decision for lumbar surgery, which soon turned out to be futile. Although the BISTs were subsequently found and removed, 5 patients believed that the lumbar surgery was unnecessary, with 4 patients expressing regrets and 1 patient threatening to take legal action against the initial surgeon.ConclusionsConcomitant symptomatic LDD and BIST-associated myelopathy pose a diagnostic challenge. Spine specialists should refrain from reflexively linking leg symptoms and impaired ability to walk to LDD. Comprehensive patient evaluation is fundamental to avoid misdiagnosis and wrong lumbar surgery.Copyright © 2017 Elsevier Inc. All rights reserved.

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