Khan Muhammad Faheem, Jooma Rashid, Hashmi Fauzan Alam, Raghib Muhammad Faraz
Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan.
Medical College, Aga Khan University Hospital, Karachi, Sindh, Pakistan.
BMJ Case Rep. 2017 Oct 9;2017:bcr-2017-219863. doi: 10.1136/bcr-2017-219863.
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.
前路颈椎间盘切除融合术（ACDF）治疗脊髓压迫是一种安全有效的手术，效果良好。然而，脊髓病恶化是该手术最令人担忧的不良事件。我们报告一例36岁男性患者，因急性非创伤性C5-6颈椎间盘突出导致不完全四肢瘫。他在C5-6节段接受了无并发症的ACDF手术，术后初期有所改善，但在第3天出现迟发性脊髓前综合征，无明显病因。我们回顾了文献中报道的类似病例，认为我们患者的术后病程与手术减压后脊髓延迟性缺血/再灌注损伤一致，血流通过脊髓前动脉得以恢复，我们针对此类临床事件的处理提出了建议。
