Suspicious Reperfusion Injury of Spinal Cord After Multilevel Cervical Posterior Decompression without Remarkable Surgical Insult - Two Case Reports -

Kyu Yeol Lee; Sung Gon You; Woong Kim

doi:10.4184/jkss.2014.21.2.97

Journal List > J Korean Soc Spine Surg > v.21(2) > 1076051

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Lee, You, and Kim: Suspicious Reperfusion Injury of Spinal Cord After Multilevel Cervical Posterior Decompression without Remarkable Surgical Insult - Two Case Reports -

Case Report

Journal of Korean Spine Surg 2014;21(2):97-102.

Published online: 21 June 2014

DOI: https://doi.org/10.4184/jkss.2014.21.2.97

Suspicious Reperfusion Injury of Spinal Cord After Multilevel Cervical Posterior Decompression without Remarkable Surgical Insult - Two Case Reports -

Kyu Yeol Lee, M.D., Sung Gon You, M.D., Woong Kim, M.D.

Department of Orthopedic Surgery, College of Medicine, Dong-A University

Corresponding author: Kyu Yeol Lee, M.D. Department of Orthopedic Surgery, College of Medicine, Dong-A University, 1, Dongdaesin-dong 3-ga, Seo-gu, Busan 602-715, Korea TEL: +82-51-240-2867, FAX: +82-51-243-9764

Received 16 July 2013 Revised 14 August 2013 Accepted 7 March 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Two case reports.

Objectives

We present two cases of quadriplegia after posterior decompression with fusion caused by a suspicious reperfusion injury of spinal cord without remarkable surgical insult.

Summary of Literature Review

Posterior decompression and posterolateral fusion have been reported as effective procedures in patients with multilevel myelopathy. However, postoperative spinal cord injury without remarkable intraoperative technical damage has been reported in a few articles. Reperfusion mechanism was suggested as one of the leading causes and reported in some animal models.

Materials and Methods

There was one case of ossification of the posterior longitudinal ligament and one developmental multilevel stenosis that underwent laminectomy with lateral mass instrumentation. After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases.

Results

After surgery, the patients presented with quadriplegia; MRI demonstrated swelling of the spinal cord and intramedullary lesion in two cases.

Conclusion

Although patients with such a medical condition are rare, it is difficult to predict postoperative swelling of the spinal cord before surgery. The surgeon should thus be aware of such rare disease conditions involving the spinal cord before the surgical procedure.

Keywords: Cervical myelopathy, Posterior decompression, Reperfusion injury

REFERENCES

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Fig. 1.

49-year-old man with OPLL. (A, B) Preoperative lateral radiogram and sagittal reconstruction CT scan show a posterior ossification to the vertebral bodies and mixed configuration at C3-5 (White box). (C) Postoperative lateral radiogram after posterior decompression with posterior fusion.

Fig. 2.

Preoperative and postoperative MR images of a 49-year-old man with OPLL who developed distal sensory decrease of both arms. (A) Pre-operative T2-MRI showed the presence of a high intensity area at C3-C4. (B) Postoperative T-2 MRI 2 hours after surgery revealed swelling of the spinal cord with wide spreading of the high-intensity area between C3-C4. (C) Postoperative T-2 MRI 1 week after surgery showed some degree of decrease of the swelling of the spinal cord and residual high-intensity area.

Fig. 3.

71-year-old man with multilevel spondylosis. (A, B) Preoperative lateral radiogram and sagittal reconstruction CT scan show some loss of lordosis and a posterior continuous configuration at the vertebral bodies of C3-5. (C) Postoperative lateral radiogram after posterior decompression with posterior fusion.

Fig. 4.

Preoperative and postoperative MR images of a 71-year-old-man. (A) Preoperative MRI showing severe cord compression caused by multilevel spondylosis. (B) Postoperative MRI showing decompression and presence of T2 high-signal intensity zones at C2-3 and C3-4, C4-5, high-signal intensity zones are present in the

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