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Neurologic Deficits After Cervical Laminectomy in the Prone Position

Bhardwaj, Anish†*; Long, Donlin M.; Ducker, Thomas B.; Toung, Thomas J. K.

Journal of Neurosurgical Anesthesiology: October 2001 - Volume 13 - Issue 4 - p 314-319
Case Reports

New neurologic deficits are known to occur after spine surgery. We present four patients with cervical myeloradiculopathy who underwent cervical laminectomy, fusion, or both in the prone position, supported by chest rolls. Three patients were intubated and positioned while awake, whereas the fourth patient was positioned after induction. Surgeries were successfully carried out, except for transient episodes of relative hypotension intraoperatively. On recovery from anesthesia, all patients were noted to have new neurologic deficits. Immediate CT myelography or surgical reexploration was unremarkable. All patients improved gradually with administration of high-dose steroids and induction of hypertension. Use of the prone position with abdominal compression may compromise spinal cord perfusion and lead to spinal cord ischemia. The use of frames that prevent abdominal compression, as well as avoidance of perioperative arterial hypotension, is important in maintaining adequate spinal cord perfusion during and after decompressive spinal cord surgery.

Departments of †Anesthesiology and Critical Care Medicine, ‡Neurological Surgery, and *Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland

Address correspondence and reprint requests to Thomas J. K. Toung, MD, Division of Neuroanesthesiology, Meyer 8–134, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287.

© 2001 Lippincott Williams & Wilkins, Inc.