Atypical cervical spondylotic radiculopathy resulting in a hypertensive emergency during cervical extension: A case report and review of literature

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.

Keywords: Atypical cervical spondylotic radiculopathy; Hypertensive emergency; Supine position; Endoscopic-assisted; Case report

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.