Hasan Wafa, Khan Khalid, Alomani Najla
Department of Radiology, Salmaniya Medical Complex, Manama, Bahrain.
Int J Emerg Med. 2022 Aug 25;15(1):39. doi: 10.1186/s12245-022-00443-3.
Anterior cervical discectomy and fusion procedure has been considered the surgical procedure of choice for the management of degenerative cervical myelopathy. Postoperative paresis is one of the most serious and concerning complications. The occurrence of such complications without any clear anatomic explanation (e.g., epidural hematoma) is unusual.
A 62-year-old man underwent cervical spine decompression via the anterior approach for marked central canal stenosis and spinal cord compression due to degenerative changes. The operation was performed under neuromonitoring, and a complete discectomy for the levels C3/C4, C5/C6, and C6/C7 was performed. Fluoroscopy confirmed the correct placement of the inserted plates and screws. No motor or sensory deficits were evident after postoperative recovery. However, 1 day later, the patient experienced progressive weakness in his both upper and lower extremities. A whole spine MRI study was performed to exclude epidural hematoma as the possible etiology. Although no localized fluid collection or hematoma was observed, the study demonstrated abnormal signal intensity in the spinal cord on T2-weighted images at the levels C5 to C7. Such findings were consistent with changes in cord reperfusion syndrome. The patient was administered intravenous methylprednisolone therapy. Gradual improvement in the muscle power in his both extremities was noted, and the patient was discharged with a satisfactory outcome. One month later, the MRI study was repeated and showed regression of the previously seen high T2 signal intensity in the cervical spine.
Cervical cord reperfusion injury is an extremely rare etiology of neurological deterioration following spinal cord decompressive surgeries. Clinicians need to maintain a high index of suspicion for this complication and should be familiar with its imaging appearance.
颈椎前路椎间盘切除融合术一直被认为是治疗退行性颈椎脊髓病的首选手术方法。术后麻痹是最严重且令人担忧的并发症之一。此类无明确解剖学解释（如硬膜外血肿）的并发症发生情况并不常见。
一名62岁男性因退行性变导致明显的中央管狭窄和脊髓受压，接受了前路颈椎减压手术。手术在神经监测下进行，对C3/C4、C5/C6和C6/C7节段进行了完整的椎间盘切除术。透视确认了植入钢板和螺钉的正确位置。术后恢复后未发现运动或感觉功能缺损。然而，1天后，患者双上肢和双下肢逐渐出现无力。进行了全脊柱MRI检查以排除硬膜外血肿作为可能病因。尽管未观察到局部液体积聚或血肿，但该检查在T2加权图像上显示C5至C7节段脊髓信号强度异常。这些发现与脊髓再灌注综合征的变化一致。给予患者静脉注射甲基强的松龙治疗。注意到患者双下肢肌力逐渐改善，患者出院时预后良好。1个月后，重复MRI检查，显示颈椎先前出现的高T2信号强度有所消退。
颈椎脊髓再灌注损伤是脊髓减压手术后神经功能恶化极其罕见的病因。临床医生需要对该并发症保持高度怀疑指数，并应熟悉其影像学表现。
