Spinal cord ischemia following laryngotracheal reconstruction surgery: a case report

Journal of Surgical Case Reports, 2024 · DOI: https://doi.org/10.1093/jscr/rjae253 · Published: June 1, 2024

Spinal Cord Injury Surgery Research Methodology & Design

Simple Explanation

A 20-year-old patient with subglottic and tracheal stenosis underwent a tracheal resection and end-to-end anastomosis to correct the condition. The patient's neck was positioned in hyperflexion using chin stitches to reduce tension during the procedure. Following the surgery, the patient developed paresthesias and motor weakness in both upper and lower extremities. MRI scans revealed lesions compromising the ventral spinal cord at levels C4-C5 and C6-C7. The chin stitches were removed to reduce neck flexion, and the patient was treated in the intensive care unit with vasopressors, physical therapy, and intravenous fluids to maintain adequate blood pressure. After three weeks, the patient was discharged with no neurologic deficit.

Study Duration

3 weeks

Participants

One 20-year-old patient

Evidence Level

Level 4; Case Report

Key Findings

1
The patient developed acute ischemic spinal injury following tracheal reconstruction, likely due to neck hyperflexion during and after surgery.
2
Prompt correction of neck posture, maintenance of mean arterial pressure above 90 mmHg, and early physical therapy were crucial for the patient's recovery from the spinal cord ischemia.
3
Brain angiogram ruled out arterial occlusions, suggesting that posture change probably restored arterial flow.

Research Summary

This case report describes a 20-year-old patient who developed spinal cord ischemia following laryngotracheal reconstruction surgery, likely due to neck hyperflexion. The patient presented with paresthesias and motor weakness in upper and lower extremities. Magnetic resonance imaging showed lesions compromising the ventral spinal cord. The patient's condition improved after correcting neck posture, maintaining adequate blood pressure, and undergoing physical therapy. The patient was discharged with no neurologic deficit after 3 weeks. The case highlights the importance of considering cervical anomalies and performing post-operative neurologic examinations in patients with head and cervical spine trauma undergoing laryngotracheal reconstruction. Early diagnosis and correction of neck posture are key to preventing permanent neurologic sequelae.

Practical Implications

Preoperative Assessment

Patients with head and cervical spine trauma should undergo preoperative evaluation for cervical anomalies with radiologic imaging.

Postoperative Monitoring

Neurologic examination should be performed postoperatively to detect early signs of spinal cord injury.

Interdisciplinary Approach

Management of spinal cord ischemia following laryngotracheal reconstruction requires a multidisciplinary approach including neurology/neurosurgery, critical care, and physical therapy.

Study Limitations

1
The conclusion that posture change restored arterial flow is based on indirect evidence, as a brain angiogram with neck in hyperflexion was not performed.
2
Limited number of similar reported cases
3
Not specified

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury