NECK HYPEREXTENSION is used commonly during surgical positioning to provide optimal anatomic positioning and exposure. Iatrogenic tetraplegia has been reported in patients with asymptomatic cervical stenosis after prolonged neck extension during cardiac and noncardiac surgeries. Standardized protocols to screen patients for underlying degenerative cervical disease, such as cervical spondylotic myelopathy or cervical stenosis, have been shown to alter perioperative decision-making.
1Here, the authors present the case of a patient with a significant risk of intraoperative spinal cord injury during combined cardiac and vascular surgery, which was managed successfully without complication. They discuss the pathophysiology, prevention, and treatment of this devastating complication.
- Diaz A
- Chin C
- Burks SS
- et al.
A retrospective pilot study for preoperative screening to prevent iatrogenic cervical spinal cord injury.
Cureus. 2021; 13: e12550
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- A retrospective pilot study for preoperative screening to prevent iatrogenic cervical spinal cord injury.Cureus. 2021; 13: e12550
- Cervical spondylotic myelopathy: A common cause of spinal cord dysfunction in older persons.Am Fam Physician. 2000; 62 (1073. Erratum in: Am Fam Physician 2001;63:1916): 1064-1070
- Cervical spondylotic myelopathy: A review of the evidence.Orthop Clin North Am. 2010; 41: 193-202
- Pathophysiology of cervical myelopathy.Spine J. 2006; 6: 190S-197S
- Mandibular subluxation for high carotid exposure.J Vasc Surg. 1984; 1: 727-733
- Surgical technique for carotid endarterectomy: Current methods and problems.Neurol Med Chir (Tokyo). 2020; 60: 419-428
- Surgeon's approach to the thyroid gland: Surgical anatomy and the importance of technique.World J Surg. 2000; 24: 891-897
- Diagnosis and operative management of carotid endarterectomy in patients with twisted carotid bifurcation.Neurol Med Chir (Tokyo). 2020; 60: 383-389
- Quadriplegia after off-pump coronary artery bypass surgery: Look before you place the neck in an extended position.J Cardiothorac Vasc Anesth. 2013; 27: e16-e17
- Cervical spine stenosis after uneventful coronary artery bypass surgery.J Cardiothorac Vasc Anesth. 2014; 28: e14-e15
- Tetraplegia after coronary artery bypass grafting in a patient with undiagnosed cervical stenosis.Anesth Analg. 2005; 101: 1883-1884
- Tetraplegia after coronary artery bypass, a rare complication.Ann Thorac Cardiovasc Surg. 2005; 11: 270-272
- Quadriplegia after mitral valve replacement in an infective endocarditis patient with cervical spine spondylitis.J Chest Surg. 2021; 54: 218-220
- Tetraplegia after coronary artery bypass grafting.Anesth Analg. 2003; 97: 979-980
- Quadriplegia post-coronary artery bypass graft surgery: An unusual case.Asian Cardiovasc Thorac Ann. 2018; 26: 390-391
- Tetraplegia after coronary artery bypass surgery in a patient with cervical herniation.Innovations (Phila). 2010; 5: 134-135
- Quadriparesis after cardiac surgery.J Cardiothorac Vasc Anesth. 2008; 22: 587-589
- Risk factors in iatrogenic spinal cord injury.Spinal Cord. 2017; 55: 818-822
- Tetraplegia after thyroidectomy in a patient with cervical spondylosis.Medicine (Baltimore). 2015; 94: e524
- Cervical spinal cord, root, and bony spine injuries: A closed claims analysis.Anesthesiology. 2011; 114: 782-795
- A spinal thecal sac constriction model supports the theory that induced pressure gradients in the cord cause edema and cyst formation.Neurosurgery. 2001; 48 (discussion 645-6): 636-645
- Disturbances of cerebrospinal fluid flow attributable to arachnoid scarring cause interstitial edema of the cat spinal cord.Neurosurgery. 2001; 48 (discussion 185-6): 174-185
- Spinal cord swelling with abnormal gadolinium-enhancement mimicking intramedullary tumors in cervical spondylosis patients: Three case reports and review of the literature.Asian J Neurosurg. 2010; 5: 1-9
- Spinal cord edema: Unusual magnetic resonance imaging findings in cervical spondylosis.J Neurosurg. 2003; 99: 8-13
- Venous hypertensive myelopathy associated with cervical spondylosis.Spine J. 2016; 16: e751-e754
- Dialysis-related spinal canal stenosis: A clinicopathological study on amyloid deposition and its AGE modification.J Neurol Sci. 2000; 178: 114-123
- Hemodialysis-related upper cervical extradural amyloidoma presenting with intractable radiculopathy.Eur Spine J. 2012; 21: S463-S466
- The inflammatory response to cardiopulmonary bypass: Part 2-anti-inflammatory therapeutic strategies.J Cardiothorac Vasc Anesth. 2009; 23: 384-393
- Inflammatory response to cardiopulmonary bypass: Mechanisms involved and possible therapeutic strategies.Chest. 1997; 112: 676-692
- Intraoperative neurophysiological monitoring during spine surgery: A review.Neurosurg Focus. 2009; 27: E6
- Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: A prospective analysis of 1055 consecutive patients.J Neurosurg Spine. 2008; 8: 215-221
- Comparison of transcranial electric motor and somatosensory evoked potential monitoring during cervical spine surgery.J Bone Joint Surg Am. 2004; 86: 1248-1253
- Transesophageal echocardiography-related complications.Can J Anesth. 2008; 55: 622-647
- Provocative tests in cervical spine examination: Historical basis and scientific analyses.Pain Physician. 2003; 6: 199-205
- Cervical radiculopathy.Curr Rev Musculoskelet Med. 2016; 9: 272-280
Published online: February 28, 2023
Publication stageIn Press Corrected Proof
© 2023 Elsevier Inc. All rights reserved.