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Thoracic Unilateral Spinal Cord Syndrome Following Neuraxial Anaesthesia for Periprosthetic Knee Fracture: A Case Report

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Open Journal of Anesthesiology 2019年第11期9卷 197-202页

作者： Nahir Chalup Torija Á lvaro Ramiro Ruiz Rubén Rodriguez Salas Beatriz Fuentes Benito marina nevado villafruela Manuel Cortés Guerrero Anaesthesia Critical Care Department and Pain Medicine Hospital Universitario 12 de Octubre Madrid Spain Hospital Universitario Fundación Alcorcón Alcorcón Spain Centro de Salud de Torrelodones Áreanoroeste Torrelodones Spain

Neuraxial anaesthesia is widely used in surgical procedures;overall, epidural and intrathecal techniques. Nevertheless, several outcomes should be considered. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear (0% - 0.08%), although there are several described cases of spinal cord ischemia. We present a case of thoracic unilateral spinal cord syndrome following lumbar spinal anaesthesia for periprosthetic knee fracture. Our patient suffered monoparesis in her left lower limb as well as decreasing of muscle strength and loss of tendon reflexes. The MNR showed left hyperintense intra-cord images from T7 to T12 attributed to spinal cord oedema and a lineal hypointensity related to minimal haematic component. What made this case surprising was the fact that spinal anaesthesia was performed between L3 and L4 and the patient did not suffer paraesthesia associated with local anaesthetic injection. She was treated with glucocorticoids, gabapentin and amitriptyline. She also was checked by physical rehabilitators, neurologists and Pain Unit physicians. We have found another case reported in the literature about thoracic cord injury after lumbar spinal puncture. In this paper, we report possible aetiologies according to a review and neurological evolution of the patient seven months later.

关键词： Neuraxial Anaesthesia Regional Anaesthesia Neurologic Complications Spinal Cord Injury

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