PDF(Pubmed)
Abstract：
BACKGROUND: The authors describe a rare case of transient postoperative wrist and finger drop following a prone position minimally invasive surgery (MIS) lateral microdiscectomy.
METHODS: Hand and wrist drop is an unusual complication following spine surgery, especially in prone positioning. The authors\' multidisciplinary team assessed a patient with this complication following MIS lateral microdiscectomy. The broad differential diagnosis included radial nerve palsy, C7 radiculopathy, stroke, and spinal cord injury. Given the patient\'s supinator weakness, intact pronation and wrist flexion, and transient recovery within 4 weeks, the most likely diagnosis was radial nerve neuropraxia secondary to ischemic compression. After careful consideration of the operative environment and anatomical constraints, the patient\'s blood pressure cuff was found to be the most probable source of compression.
CONCLUSIONS: Blood pressure cuff-induced peripheral nerve injury may be a source of postoperative radial nerve neuropraxia in patients undergoing spine surgery. Careful considerations must be given to the blood pressure cuff location, which should not be placed at the distal end of the humerus due to higher susceptibility of peripheral nerve compression. Spine surgeons should be aware of and appropriately localize postoperative deficits along the neuroaxis, including central versus proximal or distal peripheral injuries, in order to guide appropriate postoperative management.
METHODS: Hand and wrist drop is an unusual complication following spine surgery, especially in prone positioning. The authors\' multidisciplinary team assessed a patient with this complication following MIS lateral microdiscectomy. The broad differential diagnosis included radial nerve palsy, C7 radiculopathy, stroke, and spinal cord injury. Given the patient\'s supinator weakness, intact pronation and wrist flexion, and transient recovery within 4 weeks, the most likely diagnosis was radial nerve neuropraxia secondary to ischemic compression. After careful consideration of the operative environment and anatomical constraints, the patient\'s blood pressure cuff was found to be the most probable source of compression.
CONCLUSIONS: Blood pressure cuff-induced peripheral nerve injury may be a source of postoperative radial nerve neuropraxia in patients undergoing spine surgery. Careful considerations must be given to the blood pressure cuff location, which should not be placed at the distal end of the humerus due to higher susceptibility of peripheral nerve compression. Spine surgeons should be aware of and appropriately localize postoperative deficits along the neuroaxis, including central versus proximal or distal peripheral injuries, in order to guide appropriate postoperative management.
摘要：
背景：作者描述了一个罕见的病例，在俯卧位微创手术（MIS）外侧椎间盘切除术后，短暂的手腕和手指掉落。
方法：手和腕下垂是脊柱手术后一种不寻常的并发症，尤其是在俯卧位置。作者的多学科团队评估了MIS外侧显微椎间盘切除术后出现这种并发症的患者。广泛的鉴别诊断包括桡神经麻痹，C7神经根病,中风,和脊髓损伤。鉴于病人的旋后肌无力,完整的内旋和手腕屈曲，并在4周内短暂恢复，最可能的诊断是缺血压迫继发的radial神经失用。在仔细考虑手术环境和解剖学限制后，患者的血压袖带被发现是最可能的压迫源。
结论：血压袖带引起的周围神经损伤可能是脊柱手术患者术后桡神经神经错用的一个来源。必须仔细考虑血压袖带的位置，由于周围神经受压的敏感性较高，因此不应将其放置在肱骨的远端。脊柱外科医生应该注意并适当地定位沿神经轴的术后缺陷，包括中央与近端或远端外周损伤，以指导适当的术后管理。
方法：手和腕下垂是脊柱手术后一种不寻常的并发症，尤其是在俯卧位置。作者的多学科团队评估了MIS外侧显微椎间盘切除术后出现这种并发症的患者。广泛的鉴别诊断包括桡神经麻痹，C7神经根病,中风,和脊髓损伤。鉴于病人的旋后肌无力,完整的内旋和手腕屈曲，并在4周内短暂恢复，最可能的诊断是缺血压迫继发的radial神经失用。在仔细考虑手术环境和解剖学限制后，患者的血压袖带被发现是最可能的压迫源。
结论：血压袖带引起的周围神经损伤可能是脊柱手术患者术后桡神经神经错用的一个来源。必须仔细考虑血压袖带的位置，由于周围神经受压的敏感性较高，因此不应将其放置在肱骨的远端。脊柱外科医生应该注意并适当地定位沿神经轴的术后缺陷，包括中央与近端或远端外周损伤，以指导适当的术后管理。
