Abstract：
:Tumor excision surgeries of the spine present a distinct challenge regarding the maintenance of spinal cord blood supply because they often require preoperative embolization of segmental arteries, ligation of the corresponding nerve roots, and circumferential exposure of the dural sac. The authors present a case of delayed-onset spinal cord infarction after repeated tumor excision surgeries of the thoracic spine. A 49-year-old man had undergone a left nephrectomy for renal cell carcinoma, 2 pulmonary metastasectomies, and excision of a left sixth rib metastasis before referral to the authors' institution. He had a recurrence of the bone metastasis involving the left fourth and fifth ribs and T5 vertebra. He underwent 3 tumor excision surgeries, including spondylectomy of T5 and T7, for the repeated tumor recurrences involving the thoracic spine. These surgeries required preoperative embolization of 9 segmental arteries at 6 consecutive levels and ligation of 6 nerve roots at 3 consecutive levels. Thirty hours after the third surgery, the neurologic deficit worsened. The postoperative paraplegia was diagnosed as delayed-onset spinal cord infarction via magnetic resonance imaging. This is the first case report describing delayed-onset paraplegia due to spinal cord ischemia caused by embolization of segmental arteries and ligation of nerve roots in multi-spinal levels for spine tumor surgeries. In spine tumor surgery, embolization of bilateral segmental arteries at 4 or more consecutive levels and/or ligation of bilateral nerve roots pose a risk for ischemic spinal cord disease. [Orthopedics. 2019; 42(1):e131-e134.].
journal_name
Orthopedicsjournal_title
Orthopedicsauthors
Kobayashi M,Kato S,Murakami H,Demura S,Yoshioka K,Yonezawa N,Takahashi N,Shimizu T,Tsuchiya Hdoi
10.3928/01477447-20181023-07subject
Has Abstractpub_date
2019-01-01 00:00:00pages
e131-e134issue
1eissn
0147-7447issn
1938-2367journal_volume
42pub_type
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