Tetraparesis as clinical correlate of subacute cervical flexion myelopathy

Abstract

Context:We report the case of a 20-year-old woman who underwent tracheal resection with postoperative chinto-chest suture for 10 days, presenting with severe tetraparesis at our institution. Similar cases have been reported previously, however, not yet in the pathophysiological context of chronic cervical flexion myelopathy (Hirayama syndrome). Findings: Extensive myelopathy at cervical level is the consequence of the fixed cervical spine position due to chin-to-chest suture. Predominantly affected young individuals (age range from 20-25 years) without evidence of degenerated spine disease suggest a similar mechanism as described in Hirayama syndromedisplacement of the dura with consecutive compression of the spinal cord vasculature. Conclusions: Subacute flexion myelopathy represents a serious complication of operative/postoperative fixed cervical spine positions, warranting particular attention by respective surgeons.

Cervical Myelopathy Associated with Deep Neck Muscle Rhabdomyolysis after Polysubstance Abuse: A Case Report

“…Hirayama disease, also known as flexion myelopathy, is a slowly progressing amyotrophy in the upper extremities. To separate Hirayama disease from the acute myelopathy following neck flexion, it has been proposed that the term subacute flexion myelopathy should be used [ 8 ]. Because patients have usually had their head in a flexed position [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ], it has been suggested that neck flexion causes focal compression or stretching of the cervical cord, leading to spinal cord infarction via compromised microvascular perfusion [ 3 ].…”

“…To separate Hirayama disease from the acute myelopathy following neck flexion, it has been proposed that the term subacute flexion myelopathy should be used [ 8 ]. Because patients have usually had their head in a flexed position [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ], it has been suggested that neck flexion causes focal compression or stretching of the cervical cord, leading to spinal cord infarction via compromised microvascular perfusion [ 3 ]. In some subacute flexion myelopathy cases, the lesions shown in MRI scans were rather small [ 2 , 9 ] compared to the extensive lesions of the patients reported here.…”

“…Myelopathy associated with adjacent deep neck muscle rhabdomyolysis has been described in five single case reports after surgery performed in flexed position [ 8 ], after oxycodone use [ 10 ], and after intoxication [ 5 , 11 , 12 ]. Interestingly, only one of the patients described here recollected waking up with his head in a flexed position, suggesting that excessive head flexion is not essential for developing myelopathy.…”