Tetraplegia following parathyroidectomy in two long‐term haemodialysis patients

Abstract

We report two cases of postoperative iatrogenic tetraparesis, which occurred in different hospitals after surgery for parathyroidectomy. Both patients were on long-term haemodialysis. The prolonged neck extension usually required by this procedure was probably the main factor involved in the genesis of the spinal cord injury. Spinal abnormalities associated with chronic renal failure may have made these patients more vulnerable. In our opinion, it is advisable to investigate thoroughly any sign of spinal stenosis in patients who undergo any procedure requiring significant neck extension, particularly if on long-term haemodialysis. PMID: 19686487 [PubMed - indexed for MEDLINE

Intubation Biomechanics: Clinical Implications of Computational Modeling of Intervertebral Motion and Spinal Cord Strain during Tracheal Intubation in an Intact Cervical Spine

“…2 Most of these 11 patients had preoperatively unrecognized severe cervical spondylosis. Fourth, there are more than 20 case reports describing patients with severe cervical spondylosis and who, in the absence of a difficult intubation, suffered intraoperative cervical cord injury during noncervical spine surgery [33][34][35] the regional distribution of maximum principal strain (stretch) in sagittal and transverse sections of the cervical spinal cord at four force application locations are shown in (A) through (D). In the sagittal views, the white arrows show the locations and directions of the applied forces, and the red arrows show the locations of peak cord strain.…”

“…2 Most of these 11 patients had preoperatively unrecognized severe cervical spondylosis. Fourth, there are more than 20 case reports describing patients with severe cervical spondylosis and who, in the absence of a difficult intubation, suffered intraoperative cervical cord injury during noncervical spine surgery 33–35 (for additional references and discussion, see Supplemental Digital Content 3 [Case Reports of Perioperative Cervical Spinal Cord Injury in Patients with Cervical Spondylosis; http://links.lww.com/ALN/C742]). Accordingly, we hypothesize that patients who have severe cervical spondylosis have less tolerance to acute cord strain and consequently have greater potential to experience potentially injurious cord strain during an otherwise routine (normal force) intubation.…”

A Retrospective Pilot Study for Preoperative Screening to Prevent Iatrogenic Cervical Spinal Cord Injury

“…Iatrogenic CCS, quadriplegic injuries, and various other neurologic sequelae have been reported following a wide variety of non-spinal procedures, which include dental extraction [16], thyroidectomy [12], parathyroidectomy [17], adenotonsillectomy [18], CABG [19][20][21][22], and knee arthroplasty [23]. In a case report by Xiong et al that presented a patient who developed quadriplegia after a subtotal thyroidectomy, a summary of 14 previously published cases with iatrogenic quadriplegia following non-spinal surgeries was outlined [12].…”

A case of asystole from carotid sinus hypersensitivity during patient positioning for thyroidectomy

“…Head and neck surgeries like thyroidectomy, tonsillectomy and carotid endarterectomy necessitates the hyperextension of the head giving access to surgical site. Indeed there are case reports of patients suffering tetraplegia after parathyroidectomy as a result of hyperextension of head indicating that this extreme positioning may jeopardize blood flow to carotid and vertebral arteries leading to brainstem and cervical spine ischemia especially in older patients with degenerative cervical spine diseases [ 4 ]. Less known complication of head extension is triggering cardiovascular reflexes like carotid sinus reflex.…”