Neurologic deficits after cervical laminectomy in the prone position.
New neurologic deficits are known to occur after spine surgery. We present four patients with cervical myeloradiculopathy who underwent cervical laminectomy, fusion, or both in the prone position, supported by chest rolls. Three patients were intubated and positioned while awake, whereas the fourth patient was positioned after induction. Surgeries were successfully carried out, except for transient episodes of relative hypotension intraoperatively. On recovery from anesthesia, all patients were noted to have new neurologic deficits. Immediate CT myelography or surgical reexploration was unremarkable. All patients improved gradually with administration of high-dose steroids and induction of hypertension. Use of the prone position with abdominal compression may compromise spinal cord perfusion and lead to spinal cord ischemia. The use of frames that prevent abdominal compression, as well as avoidance of perioperative arterial hypotension, is important in maintaining adequate spinal cord perfusion during and after decompressive spinal cord surgery.
Bhardwaj
A
A
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Long
D M
DM
Ducker
T B
TB
Toung
T J
TJ
D000328:Adult; D006801:Humans; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000503:physiopathology*; D019635:Neurosurgical Procedures; D009767:Obesity, Morbid / Q000150:complications; D011183:Postoperative Complications / Q000503:physiopathology*; D016684:Prone Position / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology; D013116:Spinal Cord / Q000098:blood supply / Q000601:surgery*; D013117:Spinal Cord Compression / Q000601:surgery; D013123:Spinal Fusion; D013128:Spinal Osteophytosis / Q000601:surgery