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Locked-in syndrome following elective cervical foraminotomy: a case report

Spinal Cord Series and Cases volume 10, Article number: 32 (2024) Cite this article

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Abstract

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.

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Fig. 1: Axial CT showing cerebellar and pontine infarcts.
Fig. 2: MRI showing cerebellar hemorrhage.
Fig. 3: Post-craniectomy axial CT.

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Data availability

No data were generated as part of the current case report.

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Funding

No funding was received in connection to this study.

Author information

Authors and Affiliations

  1. Boston University Medical Center, Boston, MA, USA

    Sean P. Wrenn

  2. Mount Sinai Hospital, New York, NY, USA

    Junho Song

  3. Warren Alpert Medical School of Brown University, Providence, RI, USA

    Leslie Billington & John K. Czerwein

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  1. Sean P. Wrenn
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  2. Junho Song
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  3. Leslie Billington
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  4. John K. Czerwein
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Contributions

SPW was responsible for writing the report, updating reference lists, organizing figures, revising the report. JS was responsible for writing the report, updating reference lists, organizing figures, revising the report. LB was responsible for revising the report, updating reference lists, assisting with the surgical procedure described. JKC was responsible for revising the report, supervision, gathering patient information, gathering relevant imaging, performing the surgical procedure described.

Corresponding author

Correspondence to Junho Song.

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Competing interests

SPW, JS, LB, and JKC declare that they have no competing interests.

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Informed consent for this case report was obtained from the patient’s immediate family members.

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Wrenn, S.P., Song, J., Billington, L. et al. Locked-in syndrome following elective cervical foraminotomy: a case report. Spinal Cord Ser Cases 10, 32 (2024). https://doi.org/10.1038/s41394-024-00643-4

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