[Anesthesia of patients with injury to the cervical spine]

Central cord syndrome after total hip arthroplasty: a patient report

STUDY DESIGN

Case report.

OBJECTIVE

To present a patient with central cord syndrome injury after total hip arthroplasty performed under general endotracheal anesthesia.

SUMMARY OF BACKGROUND DATA

Central cord syndrome, a common injury usually sustained as a result of an extension injury to the cervical spine, often occurs in geriatric patients with underlying spondylotic changes. The injury results in weakness and sensory changes, which are more pronounced in the upper than in the lower extremities. Patients with this syndrome experience variable return of function, but some degree of residual deficit and spasticity is likely.

METHODS

The medical record, including the intraoperative anesthesia records, operative notes, progress notes, discharge summary, clinic notes, and radiology studies and reports, was reviewed.

RESULTS

The patient developed signs of central cord syndrome after total hip arthroplasty. Despite nonoperative intervention, including physiotherapy, the patient's upper and lower extremity weakness continued. Magnetic resonance imaging revealed evidence of cervical cord compression, and the patient underwent a cervical laminectomy, which produced mild improvement in his symptoms.

CONCLUSIONS

To avoid life-altering complications, it is important to evaluate the cervical spine (especially in the elderly), avoid neck extension during intubation, and use careful airway management in patients with suspected stenosis/spondylosis.