Thoracic paraparesis following an embolic vascular event during lumbar spinal surgery.
OBJECTIVE: A case report illustrating the rare occurrence of thoracic paraparesis following the presumed occurrence of an embolic vascular event during lumbar spinal surgery is presented. The goal is to investigate the potential causes of acute postoperative paraparesis following lumbar spine surgery. A discussion of the symptoms, diagnosis, differential diagnosis, and management of spinal cord ischemia and postembolic infarction is presented. This manuscript is intended to heighten the awareness of the potential for this rare complication to improve the speed and accuracy of diagnosis, allowing the timely institution of appropriate treatment. METHODS: Data analyzed include the patient history, preoperative and postoperative physical examination, clinical course, imaging studies, and input of various consulting services. A review of the English literature on spinal cord ischemia and postembolic infarction was performed. RESULTS: The most likely etiology for the patient's acute postoperative paraparesis appears to be related to an embolic spinal cord infarction. CONCLUSIONS: Management of a spinal cord ischemic event should focus on the following key issues: a prompt diagnosis with timely perioperative imaging studies (magnetic resonance imaging), the attainment of a normotensive state, the institution of systemic anticoagulation if clinically warranted, and maximization of physical function through early rehabilitation.