Abstract:

Spinal cord injury (SCI) during revision surgery for persistent multilevel cervical myelopathy (MCM) after an initial anterior procedure is rare. However, the pathophysiology of MCM, even prior to surgery, is a risk-factor for neurological deterioration due to the development of a “sick cord”, which reflects pathological changes in the spinal cord that lower the threshold for injury. We report a case of persistent MCM despite a three-level ACDF and corpectomy who developed an incomplete C6 tetraplegia during revision cervical laminectomy and posterior instrumentation. Intraoperative neuromonitoring signal-changes occurred in the absence of mechanical trauma. Postoperative MRI of the cervical spine demonstrated increased T2 hyperintensity and cord expansion at C3 and C4 compared to the pre-laminectomy MRI. The patient has not made improvements in her neurological status at 13 months postoperatively. The pathophysiology of MCM is discussed in addition to perioperative imaging, neuromonitoring, and use of steroids.

Authors:

Justin A. Iorio, MD, Fellow in Spinal Surgery, Hospital for Special Surgery Department of Orthopaedic Surgery, New York, NY , Andre M. Jakoi, MD, Fellow in Spinal Surgery, University of Southern California Department of Orthopaedic Surgery, Los Angeles, CA, Franklin T. Wetzel, MD, Vice-Chairperson and Professor, Temple University Department of Orthopaedic Surgery, Philadelphia, PA

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