Delayed Incomplete Paraplegia After En Bloc Spondylectomy of Thoracic Metastasis, A Case Report

Abstract

Background: Delayed paraplegia after total en bloc spondylectomy (TES) is exceptionally rare, and from the best of our knowledge, no such cases were reported yet. Case presentation: We herein report a case of delayed paraplegia which happened after TES of a solitary thoracic metastasis from renal clear cell carcinoma. After thorough evaluation, the patient received TES to expect a long-term local control. In operation, the patient suffered a short period of low blood pressure (mean synthetic pressure ＜90mmHg) which happened during vertebral prosthesis implantation. After operation, the neurological status was just as preoperative level, however, the patient suffered incomplete paraplegia 10 hours later. His symptoms and clinical examinations were consistent with infarct of anterior spinal artery and ischemia syndrome of spinal cord. The patient was given hyperbaric oxygen therapy and rehabilitation exercises after the tragedy, and he got recovery 2 months later, and showed much better than preoperative status 12 months later. Possible reasons for the delayed paraplegia were discussed, and we carefully concluded that intraoperative hypotension and manipulation both contributed to the happening of anterior spinal artery infarction. Conclusions: Based on this case and literature review, keeping blood pressure above daily level and other precautionary measures for spinal cord ischemia were recommended.