Quadriplegia After Off-Pump Coronary Artery Bypass Surgery: Look Before You Place the Neck in an Extended Position

Li, Chun-Cheng; Yie, Jr-Chi; Lai, Chih Cheng; Hung, Ming-Hui

doi:10.1053/j.jvca.2012.11.012

Cited by 10 publications

(7 citation statements)

References 6 publications

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“…The consequences are catastrophic, often leaving patients completely disabled (Table 1 ). 6 , 12 Among the 14 cases we found in the literature and summarized in Table 1 (2 cases had incomplete data), most patients had cervical spondylosis (9/14, 64.3%), were seniors (60 years or older, 8/12, 66.7%), and were men (12/13, 92.3%); only our patient was woman. Five patients had diabetes (5/12, 41.7%), and 4 patients had undergone long-term hemodialysis for end-stage renal disease (4/12, 33.3%).…”

Section: Discussionmentioning

confidence: 80%

“…Long-term hemodialysis can cause extradural amyloid deposition and thickening of the posterior longitudinal ligament, leading to cervical spondylosis and spinal cord compression. 6 , 12 Seven patients (7/14, 50%) had undergone coronary artery bypass surgery (CABG), which requires several hours to complete, so the prolonged operation may have contributed to their SCI; among them, 6 patients had hypertension (6/7, 85.7%), suggesting that hypertension might also be a risk factor for post-CABG SCI. Only 3 patients had almost complete recovery (3/13, 23.1%).…”

Section: Discussionmentioning

confidence: 99%

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Tetraplegia After Thyroidectomy in a Patient with Cervical Spondylosis

Xiong

Guan

2015

Medicine

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Cervical spondylosis is degeneration of the cervical spine that occurs during the normal course of aging, and may progress into compression of the spinal cord, or cervical spondylotic myelopathy (CSM), which can cause neurologic dysfunction. Cervical spondylosis can be identified in the majority of people older than 50 years. Many people with cervical spondylosis or CSM are asymptomatic. However, patients with CSM are at higher risk of spinal cord injury (SCI) following minor injury.A 60-year-old woman with asymptomatic cervical spondylosis underwent an elective subtotal thyroidectomy for thyroid nodules. After the surgery, she developed tetraplegia. MRI revealed spinal cord compression and injury. Main diagnoses, therapeutics interventions, and outcomes: Acute cervical SCI was diagnosed. After an emergency anterior cervical corpectomy and fusion surgery, she almost completely recovered.Iatrogenic cervical SCI after nonspinal surgeries that requires neck hyperextension is rarely reported, probably due to underdiagnosis and underreport. Among the 14 cases (including ours) published in the literature, most patients had cervical spondylosis and were senior men. Five patients had diabetes. Four patients had long-term hemodialysis. Seven patients had undergone coronary artery bypass surgery that requires prolonged operative time. Only 3 patients had almost complete recovery. Most patients were disabled. Two patients required tracheostomy for long-term ventilator support. Two patients died. These cases reiterate the potential risk of iatrogenic SCI in people with predisposing conditions such as cervical spondylosis, especially considering the rising prevalence and severity of cervical spondylosis caused by the aging of the population and modern sedentary lifestyle. Surgeries requiring prolonged neck hyperextension put patients with cervical spondylosis at risk for SCI. Failure to recognize the potential occurrence of iatrogenic SCI might endanger patients’ lives.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Tetraplegia After Thyroidectomy in a Patient with Cervical Spondylosis

Xiong

Guan

2015

Medicine

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“…Intraoperative SCI and neurological deterioration can occur even in the absence of cervical instability. [ 21 22 23 24 25 ]…”

Section: Definition Of Cervical Instabilitymentioning

confidence: 99%

“…There are reports of SCI even without intubation. [ 27 ] There are reports of cord injury in normal subjects after prolonged[ 25 ] or even short periods of extreme spinal deformation. [ 28 ] However, it is hard to point to any convincing report of an actual case of neurological deterioration due to intubation.…”

Section: Evidence Of Cervical Injury Following Intubationmentioning

confidence: 99%

Neurological deterioration during intubation in cervical spine disorders

Durga

Sahu

2014

Indian J Anaesth

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Anaesthesiologists are often involved in the management of patients with cervical spine disorders. Airway management is often implicated in the deterioration of spinal cord function. Most evidence on neurological deterioration resulting from intubation is from case reports which suggest only association, but not causation. Most anaesthesiologists and surgeons probably believe that the risk of spinal cord injury (SCI) during intubation is largely due to mechanical compression produced by movement of the cervical spine. But it is questionable that the small and brief deformations produced during intubation can produce SCI. Difficult intubation, more frequently encountered in patients with cervical spine disorders, is likely to produce greater movement of spine. Several alternative intubation techniques are shown to improve ease and success, and reduce cervical spine movement but their role in limiting SCI is not studied. The current opinion is that most neurological injuries during anaesthesia are the result of prolonged deformation, impaired perfusion of the cord, or both. To prevent further neurological injury to the spinal cord and preserve spinal cord function, minimizing movement during intubation and positioning for surgery are essential. The features that diagnose laryngoscopy induced SCI are myelopathy present on recovery, short period of unconsciousness, autonomic disturbances following laryngoscopy, cranio-cervical junction disease or gross instability below C3. It is difficult to accept or refute the claim that neurological deterioration was induced by intubation. Hence, a record of adequate care at laryngoscopy and also perioperative period are important in the event of later medico-legal proceedings.

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“…Quadriplegia has been related to long-term hemodialysis [2,3], asymptomatic or undiagnosed cervical spondylosis or herniated disc [4][5][6][7][8], cervical meningioma [9], symptomatic cervical spondylosis [10], and undetected atlanto-axial instabililty [11] according to a review of the literature. There were several cases of hyperextension injury associated with CABG in the literature: 4 cases related to undiagnosed or asymptomatic cervical spondylosis [4][5][6]8], 1 case related to undiagnosed cervical disc herniation [7], 1 case with previous cervical spondylosis [10], and 1 case with hemodialysis associated with extradural amyloid deposition and cervical spondylosis [2]. Cervical cord injury might be induced by aggravating pre-existing spinal canal stenosis during surgery.…”

mentioning

confidence: 99%

Quadriplegia as a position-related complication after parotidectomy: the need for cooperation between anesthesiologists and surgeons when positioning patients - A case report -

et al. 2017

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Peripheral nerve damage associated with patient positioning occurs not infrequently. However, quadriplegia following non-spinal surgeries is a rare complication. Several reports claim injury resulting from hyperextension of the cervical spine. Most of these cases were related to pre-existing cervical spondylosis and cervical spinal stenosis, in which the spinal cord was vulnerable to damage caused by prolonged neck extension. Compression of the cervical spinal cord can lead to sequelae such as diminished fine motor skills of the hand or balance difficulties, or incontinence and complete paralysis in severe cases. We present a case of quadriplegia caused by prolonged neck hyperextension during the performance of parotidectomy and discuss reasons for cervical cord injury in similar cases. During surgery, the patient is positioned optimally according to the type of operation. Careful attention is required because damage associated with patient positioning may occur during the course of the surgery. Here, we present a case of hyperextension neck injury observed following parotidectomy. A 68-year-old man who was diagnosed with a parotid tumor underwent an elective right partial superficial parotidectomy. After surgery, the patient was not able to move his upper and lower extremities and experienced voiding difficulty. Cervical magnetic resonance imaging showed spinal cord injury at the C3-4 and C5-6 levels. High-dose steroid treatment was started, and emergency laminoplasty C4-5 to C5-6 was performed. Following laminoplasty, motor function was almost fully recovered, but proprioception was weak, and voiding difficulty remained a problem. The patient received rehabilitation treatment in the hospital for about 3 months, demonstrating improvement. He was discharged and continued treatment in the outpatient department. CASE REPoRT

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Quadriplegia After Off-Pump Coronary Artery Bypass Surgery: Look Before You Place the Neck in an Extended Position

Cited by 10 publications

References 6 publications

Tetraplegia After Thyroidectomy in a Patient with Cervical Spondylosis

Tetraplegia After Thyroidectomy in a Patient with Cervical Spondylosis

Neurological deterioration during intubation in cervical spine disorders

Quadriplegia as a position-related complication after parotidectomy: the need for cooperation between anesthesiologists and surgeons when positioning patients - A case report -

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