Acta Scientific Orthopaedics (ASOR)(ISSN: 2581-8635)

Case Report Volume 4 Issue 10

Post-operative Myelopathy (Paraplegia), Unusual Causes to Consider - Case Reports

Forshing Lui1*, Ning Zhong2, John Geraghty3, Zoe Robinow1 and Kathleen Barnett1

1California Northstate University College of Medicine, Elk Grove, CA, USA
2Kaiser Permanente Medical Center, Sacramento, CA, USA
3Kaiser Permanente Medical Center, Roseville, CA, USA

*Corresponding Author: Forshing Lui, California Northstate University College of Medicine, Elk Grove, CA, USA.

Received: August 24, 2021; Published: September 18, 2021


  Post-operative paraparesis due to spinal cord pathology (myelopathy) is an uncommon yet devastating complication related to surgery or anesthesia. Direct causes are either related to the spinal column or the procedure such as spinal fractures, spondylosis, rheumatoid and other spondyloarthropathies, spinal osteomyelitis, discitis, epidural abscess, and spinal tumors. These causes of post-operative paraparesis are more obvious and often anticipated pre-operatively. We reported two uncommon causes which needs to be considered with a high index of suspicion. These are spinal cord infarction related to aortic manipulations or interventions, intraoperative hypotension, use of vasoconstrictors with the anesthetics, or epidural anesthesia. The typical clinical presentation is acute (wake up from surgery and anesthesia) onset severe paraparesis due to an acute ischemic myelopathy. The diagnostic MRI findings are vertebral body infarction in addition to the abnormal spinal cord signal. The other rare yet important cause is functional vitamin B12 deficiency induced by use of nitrous oxide anesthesia. The diagnostic findings are high plasma methylmalonate level and the classical MRI findings of abnormal signals in the dorsal columns (the inverted V sign).

Keywords: Myelopathy; Spinal Cord Infarction; Vertebral Body Infarction; Nitrous Oxide; Subacute Combined Degeneration; Dorsal Column; Inverted V Sign


  1. Qureshi AI., et al. “A Population-Based Study of the Incidence of Acute Spinal Cord Infarction”. Journal of Vascular and Interventional Neurology 4 (2017): 44-48.
  2. Weinberg L., et al. “Post‐operative paraplegia following spinal cord infarction”. Acta Anaesthesiologica Scandinavica 4 (2002): 469-472.
  3. Chan LL., et al. “Post‐epidural analgesia spinal cord infarction: MRI correlation”. Acta Neurologica Scandinavica 4 (2002): 344-348.
  4. Kobayashi K., et al. “Spinal cord infarction following epidural and general anesthesia: a case report”. JA Clinical Reports1 (2017): 1-5.
  5. Cheshire WP., et al. “Spinal cord infarction: etiology and outcome”. Neurology2 (1996): 321-330.
  6. Faig J., et al. “Vertebral body infarction as a confirmatory sign of spinal cord ischemic stroke: report of three cases and review of the literature”. Stroke1 (1998): 239-243.
  7. Yuan JL., et al. “Nitrous oxide induced subacute combined degeneration with longitudinally extensive myelopathy with inverted V-sign on spinal MRI: a case report and literature review”. BMC Neurology1 (2017): 1-4.
  8. Narra R., et al. “Inverted V sign” in sub-acute combined degeneration of cord”. Journal of Clinical and Diagnostic Research: JCDR5 (2015): TJ01.
  9. Al-Sadawi M., et al. “Inhaled Nitrous Oxide ‘Whip-Its!’ Causing Subacute Combined Degeneration of Spinal Cord”. American Journal of Medical Case Reports12 (2018): 237.
  10. Onrust MR and Frequin ST. “Subacute combined spinal cord degeneration by recreational laughing gas (N2O) use”. Journal of Central Nervous System Disease (2019).
  11. Patel KK., et al. “Subacute combined degeneration of the spinal cord following nitrous oxide anesthesia: a systematic review of cases”. Clinical Neurology and Neurosurgery 173 (2018): 163-168.


Citation: Forshing Lui., et al. “Post-operative Myelopathy (Paraplegia), Unusual Causes to Consider - Case Reports". Acta Scientific Orthopaedics 4.10 (2021): 43-46.


Copyright: © 2021 Forshing Lui., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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