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

Abstract

  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

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Citation

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

Copyright

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.