We present a case report to remind surgeons of this unusual complication that can occur in any surgery, even posterior cervical spine surgery under general anesthesia and discuss its causes, treatment methods, and the follow-up results in the literature. The peripheral Tapia's syndrome is a rare complication of anesthetic airway management. Main symptoms are hoarseness of voice and difficulty of tongue movement. Tapia's syndrome after endotracheal general anesthesia is believed to be due to pressure neuropathy of the vagus nerve and the hypoglossal nerve caused by the endotracheal tube. To our knowledge, no report has been published or given an explanation for Tapia's syndrome after posterior cervical spine surgery. Two patients who underwent posterior cervical surgery complained hoarseness and tongue palsy postoperatively. There is no direct anatomical relation between the operation, the vagus nerves and the hypoglossal nerves, and there is no record of displacement or malposition of the endotracheal tube. After several months, all symptoms are resolved. To avoid this problem in posterior cervical spine surgery, we suggest paying special attention to the position of the endotracheal tube to avoid excessive neck flexion before and during the positioning of the patient.

This study aimed to optimize velocity-selective magnetic resonance angiography (VS-MRA) protocols for whole-neck angiography and demonstrate its feasibility in healthy subjects with comparisons to clinical 3D time-of-flight (TOF) angiography. To help optimize VS-MRA protocols, 2D phase-contrast (PC) flow imaging and 3D B0 and B1 field mappings were performed on five healthy volunteers. Based on these measurements, a slab-selective (SS) inversion preparation was applied prior to a VS saturation preparation to further suppress venous blood, while the VS preparation pulse was designed with compensation for field offsets. VS-MRA and 3D TOF were performed on six healthy subjects, and relative contrast ratios (CRs) between artery and muscle signals were calculated for twenty arterial regions for comparisons. The pre-compensated VS pulse improved the visualization of the subclavian arteries and suppression of background tissues, which involved large B0 and B1 field errors. The combination of SS and VS preparations effectively suppressed venous blood. While the relative CR values were 0.78 ± 0.08 and 0.72 ± 0.10 for VS-MRA and 3D TOF, respectively, over the twenty segments, VS-MRA outperformed 3D TOF in visualizing arterial segments of a small size or with a horizontal orientation, such as subclavian, facial, and occipital arteries. The proposed neck VS-MRA with the field-error-compensated VS preparation combined with the SS preparation is feasible and superior to 3D TOF in visualizing small and/or horizontally oriented arterial segments.

Bradycardia is the most common form of dysrhythmia developing after disruption of the sympathetic pathway by a spinal cord injury (SCI), and it can have fatal consequences, including cardiac arrest. Here, we report a case of cardiac arrest developing after cervical SCI attributable to sympathetic hypoactivity. A 26-year-old male pedestrian was admitted after a traffic accident. Radiologically, fractures were apparent at the C6–7 bilateral articular facets, and cord contusion with hemorrhage was evident at C4–7. During his stay in ICU, intermittent bradycardia was noted, but the symptoms were not specific. On the 22nd postoperative day, the patient was taken to the computed tomography suite for further evaluation and experienced cardiac arrest during a positional change. After immediate cardiac massage, the patient was resuscitated. We scheduled Holter monitoring, which detected 26 pauses, the longest of which was 17.9 s. The patient underwent cardiac pacemaker insertion. No further cardiac events were noted.

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