Iatrogenic spinal cord injury with tetraplegia after an elective non-spine surgery with underlying undiagnosed cervical spondylotic myelopathy: Literature review and case report

• Published in: Clinical neurology and neurosurgery 2019-12, Vol.187, p.105549-105549, Article 105549
• Main Authors: Mathkour, Mansour, McCormack, Erin, Hanna, Joshua, Werner, Cassidy, Skinner, Kristen, Borchardt, Jeffrey A., Dumont, Aaron S., Maulucci, Christopher M.
• Format: Article
• Language: English
• Subjects: Aging; Anesthesia; Blood pressure; Bone surgery; Carpal tunnel syndrome; Case reports; Central nervous system diseases; Cervical spondylotic myelopathy; Chronic obstructive pulmonary disease; Edema; Evidence-based practice; Hypertension; Iatrogenesis; Intubation; Ischemia; Literature reviews; Neck extension; Neck pain; Neurology; Non-spine surgery; Patients; Perfusion; Robotic surgery; Spinal cord injuries; Spinal cord injury; Spine; Surgery; Tetraplegia; Trendelenburg; Vigilance
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2019.105549

•Cervical spondylotic myelopathy can predispose patients to acute spinal cord injury during non-spine procedures.•This is a rarely reported phenomenon. We found only 17 published cases of post-operative deficits in myelopathic patients.•Cervical spondylotic myelopathy is an underdiagnosed disease. More attention is needed during pre-operative screening.•Intraoperatively, vigilance to factors affecting cord perfusion and vascular compromise (e.g. blood pressure) is imperative.•Further studies should evaluate the role of surgical positioning in the myelopathic patient (e.g. Trendelenburg). Cervical spondylotic myelopathy (CSM) can predispose to acute spinal cord injury and post-operative quadriparesis during non-spine procedures, although few accounts of this phenomenon exist within the literature. To the best of our knowledge, there are only 18 cases reported in the literature including ours with spinal cord injury following elective non-spine surgery with undiagnosed CSM. Due to multifactorial pathophysiology, the maintenance of cervical cord neutrality is not sufficient to ensure that these patients will not sustain cord injury intraoperatively as this solely addresses the role of static factors. Vigilance to factors affecting cord perfusion and vascular compromise, such as the mean arterial pressure (MAP), is imperative. Additionally, further studies should evaluate the role of positioning in the myelopathic patient and whether the steep Trendelenburg position, commonly used in robotic surgeries, contributes to spinal cord venous congestion and resultant cord ischemia in these patients given their baseline stenotic canal. This review illustrates the importance of having a heightened awareness of this common degenerative condition in our aging patient population, often a forgotten underlying medical comorbidity.