Quadriplegia after parathyroidectomy in a hemodialysis patient

Abstract

We present a case of post-operative iatrogenic quadriplegia, which occurred after subtotal parathyroidectomy. This patient was on long-term hemodialysis for 7 years. The need of prolonged neck extension for this procedure was probably the main risk factor for the spinal cord injury. Systemic hypotension which contributed to the injury in this case, should be anticipated and promptly treated to prevent further damage. Spinal deformities associated with end-stage renal disease may make such patients more susceptible. Since appropriate precautions against potential neurologic damage can be undertaken, we suggest that evaluating carefully for the pre-existing spinal stenosis before a procedure requiring prominent and prolonged hyper-extension of the neck, especially in long-term hemodialysis patients is of paramount importance.

Anatomy and Pathophysiology of Spinal Cord Injury Associated With Regional Anesthesia and Pain Medicine: 2015 Update

“…86 This current advisory acknowledges scientific and medicolegal reports of ischemic spinal cord injury in patients without obvious risk factors other than a prolonged period of frank or borderline hypotension. Although lower blood pressures are apparently safe in the vast majority of patients, there appears to exist an unpredictable subset of patients who are at risk of spinal cord injury when low blood pressure is associated with spinal stenosis, 13,66,87 anemia (reduced oxygen-carrying capacity), 66 hypocapnia, raised intrathoracic pressure (eg, during mechanical ventilation in lung-injured patients), extremes of patient position, chronic hypertension, unrecognized vascular abnormalities, variation in the LLA, or as yet undiscovered conditions. The panel therefore recommends that anesthesiologists strive to maintain blood pressure within 20% to 30% of baseline and that persistent hypotension be treated, especially in the absence of neuromonitoring that could identify any new-onset insults.…”