Chory Robert M, Craver Jason, Cone Ryan, Chory Susan
Obstetrics and Gynecology, Edward Via College of Osteopathic Medicine (VCOM) Auburn, Birmingham, USA.
Neurology, Edward Via College of Osteopathic Medicine (VCOM) Auburn, Birmingham, USA.
Cureus. 2022 Jun 15;14(6):e25979. doi: 10.7759/cureus.25979. eCollection 2022 Jun.
Perioperative change to the autonomic nervous system (ANS) in spine surgery is an uncommon occurrence but has a wide range of possible presentations including blood pressure, heart rate, and heart rate variability changes collectively referred to as dysreflexia. Increased sympathetic tone and decreased vagal output are believed to be the underlying causes of these autonomic manifestations and pose an important question as to effective treatment of these dysfunctions. Spinal nerve root decompression has shown to be a valuable tool in normalizing autonomic tone by increasing parasympathetic output, most notably to the cardiovascular system, leading to the resolution of the aforementioned cardiovascular complications. Here we report a patient with elevated blood pressure with complaints of upper extremity paresthesias. MRI showed nerve root compression, and anterior cervical discectomy was performed. Post-operatively the patient had a decrease in both systolic and diastolic blood pressure which was maintained two months after surgery and allowed for discontinuation of one anti-hypertensive medication.
脊柱手术中自主神经系统（ANS）的围手术期变化并不常见，但有多种可能的表现，包括血压、心率和心率变异性变化，统称为反射异常。交感神经张力增加和迷走神经输出减少被认为是这些自主神经表现的潜在原因，并对这些功能障碍的有效治疗提出了一个重要问题。脊髓神经根减压已被证明是一种通过增加副交感神经输出（最显著的是对心血管系统）来使自主神经张力正常化的有价值工具，从而导致上述心血管并发症的缓解。在此，我们报告一名血压升高并伴有上肢感觉异常的患者。MRI显示神经根受压，遂行颈椎前路椎间盘切除术。术后患者的收缩压和舒张压均下降，术后两个月仍保持下降状态，且停用了一种抗高血压药物。
