Perioperative Spinal Cord Injury in the Setting of Whipple Procedure for Pancreatic Adenocarcinoma in a Patient With a History of Severe Cervical Stenosis.

Autor:	Freedman B; School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA., Russo CM; Anesthesiology, Walter Reed National Military Medical Center, Bethesda, USA., Batt N; Anesthesiology, Walter Reed National Military Medical Center, Bethesda, USA., Harrison M; Anesthesiology, Walter Reed National Military Medical Center, Bethesda, USA., Frease D; Anesthesiology, Walter Reed National Military Medical Center, Bethesda, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Jul 26; Vol. 16 (7), pp. e65412. Date of Electronic Publication: 2024 Jul 26 (Print Publication: 2024).
DOI:	10.7759/cureus.65412
Abstrakt:	Perioperative spinal cord injury (POSCI) is a form of traumatic acute spinal cord injury (TSCI) in the perioperative setting that is a rare but feared complication associated with severe morbidity and mortality, often resulting in significant functional impairment and significant healthcare costs for the patient. Here, we present a case report of a 65-year-old male with a past medical history of hypertension (HTN), type-2 diabetes mellitus (T2DM), stage 4 chronic kidney disease (CKD4) with a one-year history of anorexia, weight loss, jaundice, and right lower quadrant (RLQ) pain. He underwent an endoscopic ultrasound, which showed pancreatic atrophy, marked dilation of the main pancreatic duct, and a poorly defined pancreatic head mass. The patient underwent a successful pancreaticoduodenectomy and was extubated in the operating room and transferred to the surgical intensive care unit (SICU) on an oxygen face mask without complication. Four hours later it was noted that the patient's neurological exam had acutely changed with loss of motor and sensory function from the C7 dermatome down. The patient remained stable from a cardiopulmonary standpoint, and he was urgently transferred for emergency imaging of his brain and spinal cord, which demonstrated evidence of chronic spinal canal stenosis, complete cord flattening at the C5 level with profound cord edema centered at the C5 level extending from C3 to T1. Following diagnosis, neurosurgery was consulted at the SICU and a comprehensive neurological exam was performed. It was determined the patient had a grade A injury via the American Spinal Injury Association (ASIA) Impairment Scale and required an emergency cervical laminectomy. The patient was taken back to the operating room (OR) and an open cervical laminectomy was performed from C3 to C7 without any intraoperative complications. The patient was managed by a multidisciplinary SICU team for both his pancreaticoduodenectomy, perioperative traumatic acute spinal cord injury, and subsequent multilevel cervical laminectomies. The patient had a purposeful neurological recovery over the following weeks and was ultimately discharged to an inpatient physical rehabilitation facility. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Freedman et al.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu