Prone position surgery for a professional sumo wrestler with thoracic ossification of the posterior longitudinal ligament resulting in intraoperative brachial plexus injury by hypertrophic pectoral muscles
Prone position surgery for a professional sumo wrestler with thoracic ossification of the posterior longitudinal ligament resulting in intraoperative brachial plexus injury by hypertrophic pectoral muscles
复制标题
DOI：
10.1016/j.jocn.2019.01.047
复制
发表时间：
2019-05-01
影响因子：
2
通讯作者：
Nakashima, Yasuharu
中科院分区：
文献类型：
--
作者：
Saiwai, Hirokazu;Okada, Seiji;Nakashima, Yasuharu
俯卧位手术与各种由于体位引起的并发症有关，包括广泛认识到的周围神经压迫损伤和臂丛神经病变。以往的研究表明，瘦体型是俯卧位手术导致周围神经压迫性损伤的易感因素。然而，俯卧位相关的臂丛神经损伤的患者谁是超重，由于肌肉肥大从来没有报道。在此我们报告一位职业相扑选手合并严重胸椎后纵韧带骨化症的病例。胸椎后纵韧带骨化症经后路脊柱融合减压手术成功治疗。尽管术前模拟和术中检查患者的手术定位，但患者在手术后立即出现双侧上肢瘫痪。术后腋窝MRI图像显示其胸肌和腋窝两侧有一个高信号区，这意味着肋骨和胸垫之间的胸肌被推向腋窝，导致压迫性臂丛神经损伤。他的上肢运动瘫痪在6个月内完全恢复，但即使在手术后12个月，他仍然有轻微的刺痛感。总之，肌肉肥大的超重患者在俯卧位手术中存在胸肌压迫臂丛神经损伤的风险，因此使用宽胸垫来减少胸肌的压力以防止其被推向腋窝会更有效。(C)2019爱思唯尔有限公司版权所有。
Surgery in the prone position is associated with a variety of complications due to the positioning, including the widely recognized peripheral nerve compression injuries and brachial plexus neuropathy. Previous studies have reported that thin body habitus is a predisposing risk factor for the compressive peripheral nerve injuries due to the prone position surgery. However, prone-position-related brachial plexus injury in patients who are overweight due to hypertrophic muscles have never been reported. Here we report a case of a professional sumo wrestler with severe thoracic ossification of the posterior longitudinal ligament (OPLL). Thoracic OPLL was successfully treated by posterior spinal fusion and decompression surgery. Despite a preoperative simulation and intraoperative inspection of the patient's surgical positioning, he suffered from bilateral upper extremity paralysis immediately after the surgery. Postoperative axillary MRI image revealed a high-intensity area on both sides of his pectoral muscles and axillary fossa, which implied that the pectoral muscles between the ribs and chest pad were pushed out toward the axillary fossa, resulting in compressive brachial plexus injury. His upper extremity motor paralysis was fully recovered in 6 months, but he still has mild tingling sensation even after 12 months of his surgery. In conclusion, overweight patients with hypertrophic muscles pose a risk for brachial plexus entrapment injury by pectoral muscles during prone-position surgery, and therefore it would be more effective to use a wide chest pad to reduce the pressure on the pectoral muscles to prevent it from being pushed out toward the axillary fossa. (C) 2019 Elsevier Ltd. All rights reserved.