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Chambrin G, La Croix C, Jameleddine E, Laccourreve O. Acute cervical spinal cord injury after head and neck surgery: A CARE case report. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:99-102. [PMID: 37806922 DOI: 10.1016/j.anorl.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To describe and analyze a case of acute spinal cord injury after head and neck surgery. DESCRIPTION One hour after left lobo-isthmectomy under laryngeal neuromonitoring for a 3-cm EU-TIRADS 4 - Bethesda 4 thyroid nodule in a 48-year-old euthyroid male without any known comorbidity, left hemiparesis occurred. Cervical spine MRI showed an anteromedial herniated C6-7 disk with medullary compression. The disk was resected, compression was released and C6-7 fusion was performed via an anterior cervical approach on postoperative day 1. Postoperative course was unremarkable, with complete recovery of motion within 2 days. One month later, neurological clinical examination was normal and interview revealed left cervicalgia with onset a few days prior to lobo-isthmectomy. One year later, at the time of writing, the patient was doing fine. CONCLUSION Otorhinolaryngologists and head and neck surgeons must be aware of the risk of acute cervical spinal injury after cervical mobilization in head and neck surgery, and should take all measures to avoid this exceptional but dramatic complication.
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Affiliation(s)
- G Chambrin
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, HEGP, AP-HP, université Paris Cité, 20-40, rue Leblanc, 75015 Paris, France.
| | - C La Croix
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, HEGP, AP-HP, université Paris Cité, 20-40, rue Leblanc, 75015 Paris, France
| | - E Jameleddine
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, HEGP, AP-HP, université Paris Cité, 20-40, rue Leblanc, 75015 Paris, France
| | - O Laccourreve
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, HEGP, AP-HP, université Paris Cité, 20-40, rue Leblanc, 75015 Paris, France
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Gadomski BC, Hindman BJ, Page MI, Dexter F, Puttlitz CM. Intubation Biomechanics: Clinical Implications of Computational Modeling of Intervertebral Motion and Spinal Cord Strain during Tracheal Intubation in an Intact Cervical Spine. Anesthesiology 2021; 135:1055-1065. [PMID: 34731240 PMCID: PMC8578403 DOI: 10.1097/aln.0000000000004024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In a closed claims study, most patients experiencing cervical spinal cord injury had stable cervical spines. This raises two questions. First, in the presence of an intact (stable) cervical spine, are there tracheal intubation conditions in which cervical intervertebral motions exceed physiologically normal maximum values? Second, with an intact spine, are there tracheal intubation conditions in which potentially injurious cervical cord strains can occur? METHODS This study utilized a computational model of the cervical spine and cord to predict intervertebral motions (rotation, translation) and cord strains (stretch, compression). Routine (Macintosh) intubation force conditions were defined by a specific application location (mid-C3 vertebral body), magnitude (48.8 N), and direction (70 degrees). A total of 48 intubation conditions were modeled: all combinations of 4 force locations (cephalad and caudad of routine), 4 magnitudes (50 to 200% of routine), and 3 directions (50, 70, and 90 degrees). Modeled maximum intervertebral motions were compared to motions reported in previous clinical studies of the range of voluntary cervical motion. Modeled peak cord strains were compared to potential strain injury thresholds. RESULTS Modeled maximum intervertebral motions occurred with maximum force magnitude (97.6 N) and did not differ from physiologically normal maximum motion values. Peak tensile cord strains (stretch) did not exceed the potential injury threshold (0.14) in any of the 48 force conditions. Peak compressive strains exceeded the potential injury threshold (-0.20) in 3 of 48 conditions, all with maximum force magnitude applied in a nonroutine location. CONCLUSIONS With an intact cervical spine, even with application of twice the routine value of force magnitude, intervertebral motions during intubation did not exceed physiologically normal maximum values. However, under nonroutine high-force conditions, compressive strains exceeded potentially injurious values. In patients whose cords have less than normal tolerance to acute strain, compressive strains occurring with routine intubation forces may reach potentially injurious values. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Benjamin C Gadomski
- Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado
| | - Bradley J Hindman
- the Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - Mitchell I Page
- Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado
| | - Franklin Dexter
- the Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - Christian M Puttlitz
- Department of Mechanical Engineering, School of Biomedical Engineering, Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado
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Diaz A, Chin C, Burks SS, McCarthy D, Matadial C, Levene HB. A Retrospective Pilot Study for Preoperative Screening to Prevent Iatrogenic Cervical Spinal Cord Injury. Cureus 2021; 13:e12550. [PMID: 33564543 PMCID: PMC7863023 DOI: 10.7759/cureus.12550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE The preoperative medical clearance process is well established to screen for medical comorbidities and therefore must be thorough. However, screening for potential cervical spine disease is often overlooked. In older surgical candidates, the presence of cervical spondylosis can increase risk of iatrogenic cervical spine injury during prolonged neck extension in non-spinal surgeries. We present a standard protocol for cervical spine clearance and a novel sustained neck extension maneuver through a retrospective case series. METHODS Sixty-three consecutive cases that underwent preoperative cervical clearance between April 2012 and December 2019 were reviewed. Referral for clearance occurred through the department of anesthesiology after concerning radiographic or physical exam findings were noted. A standard preoperative screening protocol with a sustained one-minute neck extension maneuver was implemented. Recommendations were made for standard neck precautions with or without neuromonitoring or for cervical spine decompression surgery prior to the planned procedure. RESULTS There were 25 patients with symptoms of myelopathy, 11 with radiculopathy and 13 with neck pain at baseline. Cervical spondylosis was observed in 51 patients, cervical canal stenosis in 29 and cervical myelomalacia in six. Fifty-seven patients underwent neck extension exam and 25 exhibited new or worsening symptoms. Myelopathic symptoms and radicular pain at baseline and positive Hoffman's and Spurling's sign, independently, were significantly associated with a positive neck extension exam (p<0.05). Fourteen patients were recommended for cervical decompression prior to planned procedure. CONCLUSIONS Our preoperative cervical spine clearance protocol is safe and may aid in identifying patients susceptible to iatrogenic cervical spine injury.
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Affiliation(s)
- Anthony Diaz
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Christopher Chin
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Stephen S Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - David McCarthy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Christina Matadial
- Department of Anesthesiology, University of Miami Miller School of Medicine/Miami Veteran Affairs Healthcare System, Miami, USA
| | - Howard B Levene
- Research, Miami Veterans Hospital, Miami, USA.,Neurological Surgery, Levene Neurosurgical Consulting, Inc, Miami, USA
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Mathkour M, McCormack E, Hanna J, Werner C, Skinner K, Borchardt JA, Dumont AS, Maulucci CM. Iatrogenic spinal cord injury with tetraplegia after an elective non-spine surgery with underlying undiagnosed cervical spondylotic myelopathy: Literature review and case report. Clin Neurol Neurosurg 2019; 187:105549. [DOI: 10.1016/j.clineuro.2019.105549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
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Shim SM, Park JH, Hyun DM, Cho SH, Lee HM. Quadriplegia as a position-related complication after parotidectomy: the need for cooperation between anesthesiologists and surgeons when positioning patients - A case report -. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.4.398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Sung-Min Shim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jae-Ho Park
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Dong-Min Hyun
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sang-Hyeon Cho
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hwa-Mi Lee
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Lilitsis E, Papaioannou A, Hatzimichali A, Spyridakis K, Xenaki S, Chalkiadakis G, Chrysos E. A case of asystole from carotid sinus hypersensitivity during patient positioning for thyroidectomy. BMC Anesthesiol 2016; 16:85. [PMID: 27716078 PMCID: PMC5052875 DOI: 10.1186/s12871-016-0255-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 09/29/2016] [Indexed: 11/26/2022] Open
Abstract
Background We present a case of a patient with multinodular goiter disease who suffered asystole during head hyperextension for surgical positioning on the operational table. Case Presentation Manipulation of carotid sinus may trigger bradycardia or even asystole even in patients without prior history of carotid sinus hypersensitivity. The time proximity between patient positioning and asystole, the late responsiveness to atropine, the immediate increase of heart rate after head elevation and the lack of any other trigger factor or prior history support the hypothesis of carotid sinus syndrome. Conclusions Head hyperextension during surgical positioning is not only responsible for jeopardizing blood flow to spinal cord and brainstem but may trigger reflexes, as well, even in patients without prior neck pathology.
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Affiliation(s)
- Emmanuel Lilitsis
- Department of Anaesthesiology, University Hospital of Crete, Heraklion, Crete, Greece
| | - Alexia Papaioannou
- Department of Anaesthesiology, University Hospital of Crete, Heraklion, Crete, Greece
| | | | | | - Sofia Xenaki
- Department of General Surgery, University Hospital of Crete, Heraklion, Crete, Greece
| | - George Chalkiadakis
- Department of General Surgery, University Hospital of Crete, Heraklion, Crete, Greece
| | - Emmanuel Chrysos
- Department of General Surgery, University Hospital of Crete, Heraklion, Crete, Greece.
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Airway management for cervical spine surgery. Best Pract Res Clin Anaesthesiol 2016; 30:13-25. [DOI: 10.1016/j.bpa.2016.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/17/2015] [Accepted: 01/12/2016] [Indexed: 11/20/2022]
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Xiong W, Li F, Guan H. Tetraplegia after thyroidectomy in a patient with cervical spondylosis: a case report and literature review. Medicine (Baltimore) 2015; 94:e524. [PMID: 25674751 PMCID: PMC4602764 DOI: 10.1097/md.0000000000000524] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Cervical spondylosis is degeneration of the cervical spine that occurs during the normal course of aging, and may progress into compression of the spinal cord, or cervical spondylotic myelopathy (CSM), which can cause neurologic dysfunction. Cervical spondylosis can be identified in the majority of people older than 50 years. Many people with cervical spondylosis or CSM are asymptomatic. However, patients with CSM are at higher risk of spinal cord injury (SCI) following minor injury.A 60-year-old woman with asymptomatic cervical spondylosis underwent an elective subtotal thyroidectomy for thyroid nodules. After the surgery, she developed tetraplegia. MRI revealed spinal cord compression and injury. Main diagnoses, therapeutics interventions, and outcomes: Acute cervical SCI was diagnosed. After an emergency anterior cervical corpectomy and fusion surgery, she almost completely recovered.Iatrogenic cervical SCI after nonspinal surgeries that requires neck hyperextension is rarely reported, probably due to underdiagnosis and underreport. Among the 14 cases (including ours) published in the literature, most patients had cervical spondylosis and were senior men. Five patients had diabetes. Four patients had long-term hemodialysis. Seven patients had undergone coronary artery bypass surgery that requires prolonged operative time. Only 3 patients had almost complete recovery. Most patients were disabled. Two patients required tracheostomy for long-term ventilator support. Two patients died. These cases reiterate the potential risk of iatrogenic SCI in people with predisposing conditions such as cervical spondylosis, especially considering the rising prevalence and severity of cervical spondylosis caused by the aging of the population and modern sedentary lifestyle. Surgeries requiring prolonged neck hyperextension put patients with cervical spondylosis at risk for SCI. Failure to recognize the potential occurrence of iatrogenic SCI might endanger patients' lives.
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Affiliation(s)
- Wei Xiong
- From the Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abd-Elsayed AA, Farag E. Anesthesia for cervical spine surgery. ANESTHESIA FOR SPINE SURGERY 2012:178-187. [DOI: 10.1017/cbo9780511793851.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Caltot E, Hélaine L, Cadic A, Muller C, Arvieux CC. [Cervical disc hernia decompensation complicated by postoperative transitory tetraparesia about long-term haemodialysis patient]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2011; 30:594-596. [PMID: 21684101 DOI: 10.1016/j.annfar.2011.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 04/13/2011] [Indexed: 05/30/2023]
Abstract
We report a case of a 51-year-old man who underwent a third kidney transplantation that was complicated by tetraparesia due to a C5-C6 cervical disc hernia decompensation in the immediate postoperative period. Preoperative consultation for long-term haemodialysis patients could be perfected by further neurological investigation and additional imagery.
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Affiliation(s)
- E Caltot
- Service d'anesthésie-réanimation, CHU La Cavale Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex, France
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Wang YC, Huang SY, Lin HT, Hu JS, Chan KH, Tsou MY. Quadriplegia after parathyroidectomy in a hemodialysis patient. ACTA ACUST UNITED AC 2011; 49:32-4. [DOI: 10.1016/j.aat.2010.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 07/10/2010] [Accepted: 07/11/2010] [Indexed: 11/25/2022]
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Carron M, Veronese S, Ori C. Tetraplegia following thyroidectomy in a patient with spinal meningioma. Br J Anaesth 2010; 104:786-7. [PMID: 20460575 DOI: 10.1093/bja/aeq106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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