Bilateral vocal cord palsy after a posterior cervical laminoplasty.
Bilateral vocal cord palsy after a posterior cervical laminoplasty.
复制标题
颈椎后路椎板成形术后双侧声带麻痹。
DOI：
10.1007/s00586-018-5649-2
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Akiyama H.
中科院分区：
文献类型：
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作者：
Iwai C;Fushimi K;Nozawa S;Shirai Y;Ogawa H;Yasura K;Shimizu K;Akiyama H.
目的报道1例颈椎椎板成形术后双侧声带麻痹患者，经气管切开和重症呼吸护理后存活。颈椎后路减压术后双侧声带麻痹的发生率极为罕见。作者报告一位71岁女性，因后纵韧带骨化而患上脊髓型颈椎病。C2~C6椎板成形术，C2椎板切除。手术后成功拔管。急性起病的吞咽困难和喘鸣发生在拔管后2小时。术后纤维喉镜检查发现双侧声带麻痹。经过气管切开和加强呼吸护理，她在术后2个半月完全恢复。讨论这种病理的一个潜在原因是术中颈部过度屈曲，这可能导致喉部机械撞击，导致声带肿胀和浮肿，并导致喉返神经麻痹。在插管和拔管过程中直接损伤声带也可能导致声带瘫痪。结论我们报告了一例双侧声带麻痹合并颈椎后路椎板成形术。脊柱后路手术后的呼吸道并发症很少见，但确实会发生；因此，脊柱外科医生应该意识到这些并发症，并采取必要的预防措施，防止术中颈部位置、插管技术，甚至气管内导管的放置。
PurposeTo report a patient with bilateral vocal cord palsy following cervical laminoplasty, who survived following a tracheotomy and intensive respiratory care.MethodsAcute respiratory distress is a fatal complication of cervical spinal surgery. The incidence of bilateral vocal cord palsy after posterior cervical decompression surgery is extremely rare. The authors report a 71-year-old woman who suffered from cervical myelopathy due to ossification of the posterior longitudinal ligament. Open-door laminoplasty from C2 to C6 and laminectomy of C1 were performed. Following surgery, extubation was successfully conducted. Acute-onset dysphagia and stridor had occurred 2 h following extubation. A postoperative fiber optic laryngoscope revealed bilateral vocal cord palsy. After a tracheotomy and intensive respiratory care, she had completely recovered 2 months after surgery.DiscussionOne potential cause of this pathology was an intraoperative hyper-flexed neck position, which likely induced mechanical impingement of the larynx, resulting in swelling and edema of the vocal cords and recurrent laryngeal nerve paresis. Direct trauma of the vocal cords during intubation and extubation could have also induced vocal cord paralysis.ConclusionsWe reported a case of bilateral vocal cord palsy associated with posterior cervical laminoplasty. Airway complications following posterior spinal surgery are rare, but they do occur; therefore, spine surgeons should be aware of them and take necessary precautions against intraoperative neck position, intubation technique, even positioning of the intratracheal tube.