Background: Brown-Séquard syndrome (BSS) is a rare neurological condition characterized by injury to one-half of the spinal cord. In the context of trauma, BSS is typically seen with penetrating injuries. Here, the authors present the unique case of a patient presenting with BSS after blunt trauma.
Observations: A 70-year-old male with a history of right cervical hemilaminectomies from C4 to C6 and ossification of the posterior longitudinal ligament (OPLL) presented after a motor vehicle collision. He had left-sided weakness (American Spinal Injury Association [ASIA] grade C with a motor score of 45 and a neurological level of C4), left-sided sensory loss, and right-sided loss of sensation to painful stimulation. Magnetic resonance imaging revealed significant spinal cord compression from C2 to C6, with intramedullary signal from C2 to C5. The patient underwent urgent C2-6 laminectomies with C2-5 instrumented fusion. Intraoperative ultrasound confirmed complete decompression as well as visualized a hyperechoic signal, particularly in the left C3-4 hemicord, evident of spinal cord injury. Postoperatively, his ASIA motor score improved to 56 at the 6-week follow-up.
Lessons: This case highlights a unique scenario in which prior decompressive surgeries could have provided a protective effect on the spinal cord at the levels with concomitant OPLL and hemilaminectomies, potentially preventing complete tetraplegia. https://thejns.org/doi/10.3171/CASE24637.
Keywords: Brown-Séquard syndrome; OPLL; hemilaminectomies; ossification of the posterior longitudinal ligament; spinal cord injury.