Tetraplegia after thyroidectomy in a patient with cervical spondylosis: a case report and literature review

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.

FIGURE 1

(A) Plain x-ray taken 1 month prior to surgery showing fusion of C2–C3, osteophyte formation, and decreased height of the intervertebral space at C6–C7. (B) Sagittal T2-weighted MRI performed 1 day after thyroidectomy showing herniation of C5–C6 and C6–C7 intervertebral discs causing compression of the spinal cord, and increased signal intensity of the spinal cord from C4 to C7 indicating cord injury. (C) Sagittal T2-weighted MRI 1 week after spinal surgery (C5–C6, C6–C7 discectomies, C7 subtotal corpectomy and fusion) showing excellent spinal cord decompression.