Anterior cervical myelopathy in the early postoperative period

Abstract

Purpose: The onset of anterior cervical myelopathy in the early postoperative period is an unusual complication after cardiac surgery without extracorporeal circulation in which haemodynamic stability was maintained. We report a patient who developed anterior cervical myelopathy after cardiac surgery.Clinical features: A 53-yr-old man with no serious associated medical problems underwent cardiac surgery without extracorporeal circulation to repair a ruptured left ventricle. Haemodynamic stability was maintained throughout the procedure but the patient developed flaccid paraparesis and dissociated sensory loss, three hours later. Early recognition of the clinical picture and prompt initiation of steroid treatment facilitated a successful outcome. The definitive diagnosis was based on magnetic resonance findings days after surgery. Conclusion:The onset or aggravation of neurological symptoms in the postoperative period may be avoided by thorough search for medullary pathology in the patient's background and by using particular care when performing manoeuvres during the perioperative period, not only to ensure haemodynamic stability, thus preserving medullary perfusion, but also to avoid mechanical compression of a spinal segment.Objcctif : l'apparition ,~ la I:~riode postop~ratoire d'une my61opathie cervicale ant(~neure constitue une complication inusit6e pour une intervention cardiaque sans circulation extracorporelle (CEC) et sans alt6ration de la stabilit6 h6modynamique. Nous rapportons le cas d'un patient victime d'une my61opathie cervicale aphis une chirurgie cardiaque.Elements diniques : Un homme de 53 sans probl~mes m~dicaux associ6s importants a subi une chirurgie sans CEC pour la r~paration d'une rupture ventriculaire gauche. La stabilit6 h~modynamique a ~t~ maintenue pendant I'intervention mais le patient a d~velopp6 une parapar6sie flasque et une perte de sensibilit6 dissoci6e trois heures apr~s I'intervention. La reconnaissance pr~coce du tableau clinique et I'initiation rapide de la corticoth6rapie a permis une ~volution favorable.Conclusion : ~, la pEdode postol~ratoire, I'apparition et I'aggravation de sympt6mes neurologiques peuvent 6tre 6vit6es par la recherche mEticuleuse d'une pathologie m6dullaire prEalable. Pendant la p~riode p~riop~ra-toire, il faut assurer la stabilit~ h~modynamique et ~iter la compression m~canique du rachis.