Cui HC, Chang ZQ, Zhao SK. Atypical cervical spondylotic radiculopathy resulting in a hypertensive emergency during cervical extension: A case report and review of literature. World J Orthop 2024; 15(10): 981-990 [PMID: 39473513 DOI: 10.5312/wjo.v15.i10.981]
Corresponding Author of This Article
Zheng-Qi Chang, MD, Associate Chief Physician, Associate Professor, Department of Orthopedics, 960th Hospital of PLA, No. 25 Shifan Road, Tianqiao District, Jinan 250031, Shandong Province, China. 26766771@qq.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Oct 18, 2024; 15(10): 981-990 Published online Oct 18, 2024. doi: 10.5312/wjo.v15.i10.981
Atypical cervical spondylotic radiculopathy resulting in a hypertensive emergency during cervical extension: A case report and review of literature
Hao-Cheng Cui, Zheng-Qi Chang, Shao-Ke Zhao
Hao-Cheng Cui, Zheng-Qi Chang, Shao-Ke Zhao, Department of Orthopedic Surgery, 960th Hospital of PLA, Jinan 250031, Shandong Province, China
Author contributions: Cui HC and Chang ZQ made substantial contributions to acquisition, analysis and interpretation of data; Chang ZQ was responsible for the conception and design of the study and Cui HC was responsible for the drafting and writing of this manuscript; Zhao SK and Cui HC were a surgical assistant. All authors confirm the authenticity of all the raw data.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zheng-Qi Chang, MD, Associate Chief Physician, Associate Professor, Department of Orthopedics, 960th Hospital of PLA, No. 25 Shifan Road, Tianqiao District, Jinan 250031, Shandong Province, China. 26766771@qq.com
Received: May 16, 2024 Revised: September 6, 2024 Accepted: September 14, 2024 Published online: October 18, 2024 Processing time: 147 Days and 17.8 Hours
Abstract
BACKGROUND
Extensive research revealed the absence of reports documenting hypertensive emergencies precipitated by changes in the cervical spine posture.
CASE SUMMARY
We here present a 57-year-old woman diagnosed as having cervical spondylotic radiculopathy (CSR) who was scheduled for anterior cervical decompression and fusion. During post-anesthetic positioning, a sudden hypertensive surge was observed when the patient was in a supine position with the neck being slightly extended. This surge was promptly reversed through cervical flexion and head elevation. This event however required an alternate surgical approach for recovery—posterior laminoplasty and endoscopy-assisted nucleus pulposus removal. Following the 6-month outpatient follow-up period, cervical flexion and extension activities substantially improved in the patient without any episodes of increase in acute blood pressure.
CONCLUSION
Maintaining a safe hypotensive posture and performing rapid, thorough decompression surgery may serve as effective interventions for patients presenting symptoms similar to those of CSR accompanied by hypertensive emergencies (HE). This would mitigate the underlying causes of these HEs.
Core Tip: Cervical spondylotic radiculopathy (CSR) is the most common form of cervical spondylotic disease. To date, no study has documented any link between CSR and hypertensive emergencies. We here present a case of a typical patient with CSR who experienced a hypertensive crisis during the preparatory phase for anterior cervical discectomy and fusion surgery. This event was attributable to slight cervical spine hyperextension. Ultimately, the patient's CSR was resolved through posterior cervical canal expansion and foraminoscope-assisted transforaminal nucleus pulposus extraction. After the 6-month follow-up period, the patient exhibited normal neck flexion and blood pressure was stable during neck movements.
