Introduction

There are no previously reported cases of locked-in syndrome occurring following cervical spinal surgery. We describe a case of locked-in syndrome following an elective cervical foraminotomy and discuss potential etiologies and contributing factors to our patient’s presentation.

Case presentation

A 54-year-old male with a history of head and neck cancer and prior anterior cervical discectomy and fusion presented with neck pain following a motor vehicle accident. The patient underwent C4-C7 left-sided cervical posterior foraminotomy with no intraoperative complications. On postoperative day 1, the patient suddenly developed rapidly progressing weakness of the extremities and soon became non-verbal. CT angiography and near-infrared spectroscopy confirmed a basilar artery occlusion and left vertebral artery dissection. On MRI, infarcts involving the bilateral pons, left cerebral hemisphere, and left cerebellar infarct were identified.

Conclusion

The etiology of locked-in syndrome in our patient remains unclear, but it is likely multifactorial. It is possible that the patient was predisposed to vascular injury from prior radiation therapy to the head and neck. In addition, intraoperative vascular insult may have occurred from vibrational shear stress, in turn leading to a vertebral artery dissection, basilar artery occlusion, and pontine infarct, ultimately resulting in our patient’s locked-in state.

中文翻译：

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选择性颈椎椎间孔切开术后闭锁综合征：病例报告

 介绍

此前没有报道颈椎手术后发生锁定综合征的病例。我们描述一例选择性颈椎椎间孔切开术后出现闭锁综合征的病例，并讨论潜在的病因和导致患者表现的因素。

 案例展示

一名 54 岁男性，有头颈癌病史，曾接受过前路颈椎间盘切除融合术，在一次机动车事故后出现颈部疼痛。患者接受了C4-C7左侧颈椎后路椎间孔切开术，没有术中并发症。术后第一天，患者突然出现四肢迅速进展的无力，很快就无法说话。 CT血管造影和近红外光谱证实基底动脉闭塞和左侧椎动脉夹层。 MRI 发现梗塞涉及双侧脑桥、左侧大脑半球和左侧小脑梗塞。

 结论

该患者闭锁综合征的病因尚不清楚，但可能是多因素的。患者可能因之前的头部和颈部放射治疗而容易受到血管损伤。此外，术中的血管损伤可能是由振动剪切应力引起的，进而导致椎动脉夹层、基底动脉闭塞和脑桥梗塞，最终导致患者处于锁定状态。