Spinal Cord Reperfusion Injury Syndrome: A Rare Post-SurgicalComplication after Spinal Cord Decompression that Makes theSurgeon Doubtful about his Surgical Skills

Abstract

Background: Spinal cord reperfusion injury syndrome (SCRIS) is a very rare pathology with little literature on the subject. The pathophysiology of SCRIS/ WCS is poorly understood to date but the most widely accepted is that the sudden increase in blood flow at the level of the medullary compression area would cause the release of free radicals, causing damage to the axonal membrane. Severe or post-surgical tetraplegia together with an emergency magnetic resonance imaging (MRI) in which spinal cord hyperintensity is observed on T2 will make us suspect the diagnosis once the most frequent complications of spinal cord decompression have been ruled out.

Purpose: Understand and evaluate decision-making when facing a case of SCRIS/WCS.
Study Setting: Case report.
Objective: Evaluate the appropriate approach to SCRIS/WCS and review the literature.

Clinical Observation: we report a rare case of spinal cord reperfusion injury in a 65-year-old female. The first case reported in Ecuador.

Conclusion: The SCRIS/WCS is a rare pathology with little literature reported so far. The most accepted physiopathology is the sudden increase in blood flow over a chronically compressed spinal cord with the consequent increase in free radicals which lead to neural membrane injury. A very important risk factor to consider is hypertension as a history of the patient. Sudden quadriplegia or immediate post-surgical spinal cord decompression will make us request a follow-up magnetic resonance imaging to evaluate the possible most frequent complications, once each of them has been ruled out and with an increase in T2-weighted intensity, it will guide us towards the diagnosis. The skill and training of the surgeon is important when making decisions because the cause of this syndrome is not of mechanical origin.