抄録
Arthroscopic shoulder surgery in the beach-chair position has been a popular method recently, but several complications have been reported. We report a case of cervical spinal cord injury during arthroscopic surgery of the shoulder in the beach-chair position under general anesthesia.
The Case was a 69-year-old man, who had been a haemodialysis patient for 25 years. He was treated with arthroscopic synovectomy and debridement at the hemodialysis shoulder. Preoperative general condition was certified class 3 in physical status of the American anesthesiology society, and we recognized his mild cervical spondylotic myelopathy before the treatment. Anesthesiologists administered general anesthesia on a stretcher, intubated trachea without any difficulty. 6 medical staff including 2 shoulder surgeons gently placed the patient on the beach-chair position, secured his neck and body, and the back of the chair was at an angle of 60 degrees to the floor. No trouble occured during the operation. When he awoke from the general anesthesia, he complained of motorweakness and dysalgesia. T2-weighted MRI revealed degenerative cervical canal stenosis and intramedullary high-intensity. We had a diagnosis of cervical cord injury. We performed steroid pulse, hyperbaric oxygen therapy, and cervical laminoplasty, so fortunately he recovered fully.
There have been several reports about nerve injury as a complication in arthroscopic shoulder surgery, and they are almost all about peripheral nerve injuries. The cause of this cervical cord injury remains uncertain. We should check the neurological status preoperatively, and frequently check the position in the beach-chair during an operation when we treat patients with suspected comorbid cervical vertebrae lesion.
