头颈部手术后急性颈脊髓损伤：一个 CARE 病例报告。
Acute cervical spinal cord injury after head and neck surgery: A CARE case report.
机构信息
Service d'otorhinolaryngologie et de chirurgie cervico-faciale, HEGP, AP-HP, université Paris Cité, 20-40, rue Leblanc, 75015 Paris, France.
Service d'otorhinolaryngologie et de chirurgie cervico-faciale, HEGP, AP-HP, université Paris Cité, 20-40, rue Leblanc, 75015 Paris, France.
出版信息
Eur Ann Otorhinolaryngol Head Neck Dis. 2024 Mar;141(2):99-102. doi: 10.1016/j.anorl.2023.09.003. Epub 2023 Oct 6.
OBJECTIVE
To describe and analyze a case of acute spinal cord injury after head and neck surgery.
DESCRIPTION
One hour after left lobo-isthmectomy under laryngeal neuromonitoring for a 3-cm EU-TIRADS 4 - Bethesda 4 thyroid nodule in a 48-year-old euthyroid male without any known comorbidity, left hemiparesis occurred. Cervical spine MRI showed an anteromedial herniated C6-7 disk with medullary compression. The disk was resected, compression was released and C6-7 fusion was performed via an anterior cervical approach on postoperative day 1. Postoperative course was unremarkable, with complete recovery of motion within 2 days. One month later, neurological clinical examination was normal and interview revealed left cervicalgia with onset a few days prior to lobo-isthmectomy. One year later, at the time of writing, the patient was doing fine.
CONCLUSION
Otorhinolaryngologists and head and neck surgeons must be aware of the risk of acute cervical spinal injury after cervical mobilization in head and neck surgery, and should take all measures to avoid this exceptional but dramatic complication.
目的
描述并分析一例头颈部手术后发生的急性脊髓损伤。
描述
一名 48 岁的甲状腺功能正常男性，无任何已知合并症，因 3cm EU-TIRADS 4-Bethesda 4 甲状腺结节在喉神经监测下行左叶-峡部切除术 1 小时后出现左侧偏瘫。颈椎 MRI 显示 C6-7 椎间盘前内侧突出，伴有脊髓受压。术后第 1 天通过前路颈椎入路切除椎间盘，解除压迫并进行 C6-7 融合。术后过程无异常，2 天内运动功能完全恢复。1 个月后，神经学临床检查正常，访谈显示左颈痛，在左叶-峡部切除术前几天开始。截至写作时，患者状况良好。
结论
耳鼻喉科和头颈部外科医生必须意识到头颈部手术中颈椎活动后发生急性颈脊髓损伤的风险，应采取一切措施避免这种罕见但严重的并发症。
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