颈椎后路减压融合手术后双侧膈神经麻痹:术后罕见病例。

IF 0.7 Q4 CLINICAL NEUROLOGY
Glenn A Gonzalez, Jingya Miao, Guilherme Porto, James Harrop
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引用次数: 0

摘要

简介延迟性 C5 无力是颈椎手术中的一个已知病例,但其临床表现各不相同,作用机制也鲜为人知。我们描述了文献中第一例颈椎后路减压融合术后双侧 C5 麻痹导致双侧膈神经功能障碍的病例:一名 76 岁的男性因腰痛前来就诊,被诊断为脊髓病。在最初的神经系统检查中,他在没有人搀扶的情况下无法下地行走,双腿步态不稳。最初的颈椎 MRI 和 CT 扫描显示,颈椎出现晚期多层次退行性病变,伴有严重的脊髓压迫和髓鞘病变。患者接受了 C3-C6 颈椎后路减压融合术(PCDF)。他醒来后进行了基线检查,术中没有神经电生理监测变化,也没有 C5 根 EMG 活动。术后对颈椎进行了核磁共振检查,结果显示减压效果良好。患者神经功能稳定,已出院前往康复机构。患者在术后第 74 天(POD)出现延迟性双侧 C5P。延迟的双侧 C5P 和膈神经损伤被确定为导致该患者呼吸困难的原因。PM&R 顾问建议放置膈肌起搏器。然而,在临床上,他的呼吸功能和运动障碍已逐渐改善:结论:双侧膈肌麻痹是颈椎手术的严重并发症,可能导致呼吸困难和上肢无力。C5P是其根本原因,可能由多种因素引起。早期发现膈肌无力并通过物理疗法和起搏器进行治疗至关重要,这强调了医护人员和外科医生保持警惕的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Bilateral phrenic nerve palsy after posterior cervical decompression and fusion surgery: a rare event after surgery.

Bilateral phrenic nerve palsy after posterior cervical decompression and fusion surgery: a rare event after surgery.

Introduction: Delayed C5 weakness is a known entity in cervical spine surgery, although with varied clinical presentation and poorly understood mechanism of action. We describe the first case in the literature of a bilateral C5 palsy leading to bilateral phrenic nerve dysfunction following a posterior cervical decompression and fusion.

Case report: A 76-year-old male presented with low back pain and was diagnosed as myelopathic. On initial neurological examination, he could not ambulate without assistance and was unsteady on tandem gait. The initial cervical MRI and CT scan showed advanced multilevel degenerative changes of the cervical spine with severe cord compression and myelomalacia. The patient underwent C3-C6 posterior cervical decompression & fusion (PCDF). He awoke with his baseline examination without neurophysiological monitoring changes intraoperatively or C5 root EMG activity. Post-operative MRI of the cervical spine was performed and showed an excellent decompression. The patient was neurologically stable and discharged to a rehabilitation facility. Patient developed a delayed bilateral C5P on postoperative day (POD) 74. Delayed bilateral C5P and phrenic nerve damage was determined to cause this patient's dyspnea. PM&R consult recommended placement of diaphragmatic pacers. However, clinically his respiratory function, as well as motor deficits, have gradually improved.

Conclusion: Bilateral diaphragmatic paralysis, a severe complication of cervical spine surgery, may cause respiratory distress and upper limb weakness. C5P, the underlying cause, may arise from various factors. Early detection and management of diaphragmatic weakness with physical therapy and pacers are crucial, emphasizing the need for vigilance by healthcare professionals and surgeons.

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来源期刊
Spinal Cord Series and Cases
Spinal Cord Series and Cases Medicine-Neurology (clinical)
CiteScore
2.20
自引率
8.30%
发文量
92
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