Erhan Belgin, Kemerdere Rahsan, Kizilkilic Osman, Gunduz Berrin, Hanci Murat
Department of Physical Medicine and Rehabilitation, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey.
Department of Neurosurgery, Subdivision of Neuroradiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.
Surg Neurol Int. 2018 Jan 16;9:11. doi: 10.4103/sni.sni_405_17. eCollection 2018.
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.
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.
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.
胸椎手术或腹部手术后的截瘫通常归因于节段性脊髓血管供应中断导致的脊髓缺血。相比之下，颈椎手术后脊髓缺血的病因尚不清楚。
一名14岁男性在因既往插管导致气管狭窄接受手术后12小时，急性出现四肢瘫，感觉平面为C4，伴有括约肌功能障碍。体征包括C4水平以下痛觉和温度觉丧失，深感觉（位置觉和振动觉）保留，足底反射消失。颈椎磁共振成像显示C2 - C7之间脊髓弥漫性肿胀，T2加权图像上脊髓前后柱出现高信号改变。该发现的各种病因包括颈椎过伸或过屈损伤与脊髓前动脉综合征。
颈椎和胸腹部手术后归因于脊髓缺血的术后治疗在逆转主要神经功能缺损方面大多无效。因此，在这些手术过程中通过避免凝血功能障碍、贫血、低血压以及过屈/过伸动作来预防缺血至关重要。
