Document Detail

Spinal cord ischemia following thoracotomy without epidural anesthesia.
MedLine Citation:
PMID:  16738288     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Paraplegia is an uncommon yet devastating complication following thoracotomy, usually caused by compression or ischemia of the spinal cord. Ischemia without compression may be a result of global ischemia, vascular injury and other causes. Epidural anesthesia has been implicated as a major cause. This report highlights the fact that perioperative cord ischemia and paraplegia may be unrelated to epidural intervention. CLINICAL FEATURES: A 71-yr-old woman was admitted for a left upper lobectomy for resection of a non-small cell carcinoma of the lung. The patient refused epidural catheter placement and underwent a left T5-6 thoracotomy under general anesthesia. During surgery, she was hemodynamically stable and good oxygen saturation was maintained. Several hours following surgery the patient complained of loss of sensation in her legs. Neurological examination disclosed a complete motor and sensory block at the T5-6 level. Magnetic resonance imaging (MRI) revealed spinal cord ischemia. The patient received iv steroid treatment, but remained paraplegic. Five months following the surgery there was only partial improvement in her motor symptoms. A follow-up MRI study was consistent with a diagnosis of spinal cord ischemia. CONCLUSION: In this case of paraplegia following thoracic surgery for lung resection, epidural anesthesia/analgesia was not used. The MRI demonstrated evidence of spinal cord ischemia, and no evidence of cord compression. This case highlights that etiologies other than epidural intervention, such as injury to the spinal segmental arteries during thoracotomy, should be considered as potential causes of cord ischemia and resultant paraplegia in this surgical population.
Aeyal Raz; Aharon Avramovich; Efrat Saraf-Lavi; Milton Saute; Leonid A Eidelman
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  53     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-06-01     Completed Date:  2006-10-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  551-5     Citation Subset:  IM    
Department of Anesthesiology, Rabin Medical Center, Campus Beilinson, Petah Tikva, 49100, Israel.
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MeSH Terms
Anesthesia, Epidural*
Carcinoma, Non-Small-Cell Lung / surgery
Lung Neoplasms / surgery
Magnetic Resonance Imaging
Paraplegia / etiology
Postoperative Complications / cerebrospinal fluid,  etiology
Spinal Cord Ischemia / cerebrospinal fluid,  diagnosis,  etiology*
Thoracotomy / adverse effects*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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