Delayed spinal cord infarction following anterior cervical surgical decompression

Abstract

Anterior cervical discectomy and fusion (ACDF) for cord compression is a safe and effective procedure with good outcomes. However, worsening of myelopathy is the most feared adverse event of the surgery. We report the case of a 36-year-old male patient who presented with an acute non-traumatic C5-6 cervical disc herniation causing incomplete quadriparesis. He underwent an uncomplicated ACDF at C5-6, and after an initial period of improvement, he developed a delayed onset of an anterior cord syndrome on day 3, without any discerning cause. We have reviewed similar cases reported in the literature and believe that our patient's postsurgical course is consistent with a delayed ischaemic/reperfusion injury to the cord following surgical decompression and restoration of blood flow through the anterior spinal artery and we make suggestions for management of such clinical events.

Keywords: mechanical ventilation; neuroimaging; neurological injury; neurosurgery; spinal cord.

Figure 1.

MRI cervical spine preprocedure, in sagittal plane T2 sequence (A) and axial T2 sequence (B), demonstrating annular tear and acute disc prolapse at C5/6 level with subtle hyperintense signal changes in the spinal cord representing oedema and cord compression.

Figure 2

. X-ray cervical spine lateral view, demonstrating bone graft and plate in place without any migration in the spinal canal.

Figure 3.

MRI cervical spine post procedure; T2 (A) and T1 (B) sequences in sagittal plane, demonstrating hyperintense signal changes in the spinal cord representing haemorrhage. One can appreciate adequate decompression, removal of the disc fragment and surgical implants in place with rest of the postsurgical changes.