Acute or delayed paraplegia or quadriplegia following anterior cervical discectomies and fusion are not common. We report this single case report of delayed quadriplegia following an anterior cervical discectomies and fusion without any change of sensory or motor evoked potentials during the operation.
The intraoperative somatosensory (SSEPs) were performed by stimulation of tibial nerves or the median (MN). Motor evoked potentials (TcMEPs) were recorded from intrinsic hand or foot muscles after delivering high voltage electrical pulses to the motor cortex.
We report a case of postoperative weakness which was followed by an incomplete quadriplegia in a patient after cervical discectomy and fusion. The intraoperative somatosensory (SSEPs) and TcMEPs recordings were normal throughout the surgery. Upon termination of the procedure and in the recovery room patient followed commands and was freely able to move all extremities. The weakness in the upper and lower limbs ensued within 20 minutes after which progressively turned into a severe weakness of upper limbs and complete motor paralysis in the lower limbs. The emergency MRI scan was not diagnostic at that point but the follow-up MRI scan a day after surgery demonstrated a multi-level spinal cord edema and infraction.
Spinal cord ischemia should be managed aggressively to improve spinal cord perfusion. The end prognosis depends on the severity of insult to neuronal tissue.