Horner Syndrome After Anterior Cervical Spine Surgery for Traumatic Spinal Cord Injury - A Rare Complication.

Horner syndrome (HS) is a rare complication of anterior cervical decompression and fusion procedures (ACDF). A 42-year-old female presented with sudden-onset weakness in both upper and lower limbs secondary to trauma and was diagnosed with a spinal cord injury with tetraplegia. Her pre-operative findings were that her motor level of injury was C4 on the right and C5 on the left, and her sensory level of injury was C4 and C5, respectively, on the right and left sides. Her neurological injury level (NLI) was C4, and her ASIA Impairment Scale score was A. The cervical spine MRI suggested compression fractures of the C5 and C6 vertebral bodies with cord compression. She underwent a C5 and C6 central corpectomy and mesh cage fusion by an anterior longitudinal incision via right-sided exposure. She developed ptosis, miosis, and anhidrosis on the side immediately after surgery. During rehabilitation admission, her neurological findings were that her motor level of injury was C4 on the right and C5 on the left, and her sensory level of injury was C4 and C5, respectively, on the right and left sides. Her NLI was C4, and her ASIA Impairment Scale score was C. Even one year after surgery, the symptoms persisted. HS is a rare complication of anterior cervical spine fixation, and it is essential to have a thorough understanding of intraoperative and postoperative ACDF-related complications to avoid them whenever possible and manage them successfully and safely when they occur.

Postural Orthostatic Tachycardia Syndrome in Spinal Cord Injury.

Spinal cord injury (SCI), in addition to motor and sensory problems, may also lead to autonomic dysfunction. Postural orthostatic tachycardia syndrome (POTS) is one of them and has often been reported in traumatic brain injuries, multiple sclerosis, and other spinal cord pathologies. However, there is not much data on POTS in SCI even in extensive databases. We present a case of an adolescent female with paraplegia due to traumatic SCI. During her tilt table training, she started having episodes of sinus tachycardia associated with fatigue, dizziness, headache, palpitations, and presyncope with no orthostatic hypotension, after achieving 60 degrees of head tilt. After ruling out the common causes of tachycardia and syncope, a diagnosis of POTS was established. With pharmacologic and non-pharmacological measures, including metoprolol, increased fluid intake, and compression stockings, her symptoms resolved, and she was able to continue rehabilitation.