title: Quadriplegia secondary to cervical spondylotic myelopathy-a rare complication of head and neck surgery.
abstract: BACKGROUND
  Free tissue reconstruction after ablation of head and neck malignancy often requires extensive cervical manipulation, which may exacerbate preexisting cervical spondylosis and result in progression to cervical myelopathy. We present a rare case of postoperative quadriplegia caused by cervical spondylotic myelopathy after head and neck reconstruction.
  
  
  RESULTS
  A 63-year-old man without a history of cervical spondylosis underwent resection of a gingivo-buccal squamous cell carcinoma with immediate reconstruction with free fibula osteocutaneous flap. On postoperative day 4, the patient was found to have quadriplegia. MRI demonstrated severe cervical myelopathy. Decompressive laminectomy was performed. The patient underwent an extensive rehabilitation program but only realized moderate improvement.
  
  
  CONCLUSIONS
  Cervical spondylotic myelopathy is a rare but disastrous complication of head and neck surgery. We hypothesize that it is potentially avoidable with heightened awareness of this disease entity, preoperative identification of patients at risk, and prophylactic interventions
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Wei-Fan
authors.initials: WF
authors.lastname: Chen
authors.forename: Chung-Jan
authors.initials: CJ
authors.lastname: Kang
authors.forename: Sai-Cheung
authors.initials: SC
authors.lastname: Lee
authors.forename: Chung-Kan
authors.initials: CK
authors.lastname: Tsao
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods / Q000534:rehabilitation; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery; D037981:Neck Dissection / Q000009:adverse effects* / Q000379:methods; D011782:Quadriplegia / Q000209:etiology / Q000601:surgery*; D035583:Rare Diseases; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000601:surgery; D055009:Spondylosis / Q000175:diagnosis / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects*; D016896:Treatment Outcome