Acute tetraplegia following laryngotracheal reconstruction surgery

Abstract

Background: Paraplegia following thoracic spinal surgery or abdominal operations is usually attributed to spinal cord ischemia due to interruption of the segmental spinal vascular supply. Alternatively, the etiology of spinal cord ischemia following cervical surgery is less clear.

Case description: A 14-year-old male became acutely tetraplegic with a C4 sensory level and sphincteric dysfunction 12 h following surgery for tracheal stenosis due to prior intubation. Signs included loss of pain and temperature below the level of C4 with preservation of deep sensations (position and vibration) and mute plantar responses. The cervical magnetic resonance imaging revealed diffuse intramedullary cord swelling between C2-C7 and hyperintense signal changes in the anterior and posterior columns of the cord on T2-weighted images. Various etiologies for this finding included a cervical hyperextension or hyperflexion injury vs. anterior spinal artery syndrome.

Conclusions: Postoperative treatment of spinal cord ischemia attributed to cervical and thoracoabdominal surgery is largely ineffective in reversing major neurological deficits. Therefore, it is critical to prevent ischemia during these procedures by the avoidance of coagulopathies, anemia, hypotension, and hyperflexion/hyperextension maneuvers.

Keywords: Anterior spinal artery syndrome; cervical; spinal cord injury; tracheal surgery.

Figure 1

T2-weighted cervical magnetic resonance images. (a) Sagittal image showing long segment swelling of the cervical spinal cord and increased signal intensity. (b) Axial image demonstrating increased signal intensity of the whole cord and swelling of the cervical spinal cord

Figure 2

Sagittal reconstruction of CT image showing cervical kyphosis and narrowing of the cervical spinal canal