Postoperative transient tetraplegia in two patients caused by cervical spondylotic myelopathy.

We report two patients with cervical spondylotic myelopathy following non-cervical spine surgery. These cases revealed postoperative transient tetraplegia with respiratory insufficiency despite optimal anaesthetic management. Both patients showed no limitation of their neck movement at pre-operative airway examination. In addition, their necks had never been overextended during anaesthesia including tracheal intubation. However, postoperative magnetic resonance imaging showed cervical spondylotic myelopathy. Cervical disc herniation and protrusion of a hypertrophic ligamentum flavum caused spinal canal cord compression, and, these may lead to tetraplegia and phrenic nerve impairment. Their muscle weakness gradually improved and completely recovered the following morning. We should consider the existence of cervical spondylosis in the elderly patients over the age of 60 years.

Degradation and biosynthesis of proteoglycans in the nucleus pulposus of canine intervertebral disc after chymopapain treatment.

The effects of chymopapain treatment of the canine intervertebral disc were studied in vivo by monitoring proteoglycan in the nucleus pulposus. Analysis of proteoglycan was carried out by Sepharose CL-4B (Pharmacia Fine Chemicals AB, Stockholm, Sweden) chromatography and electrophoresis. The proteoglycan was degraded to glycosaminoglycans within 1 week after chymopapain treatment. Two weeks later, a proteoglycan smaller than the original appeared in the nucleus pulposus. At 8 weeks after injection, the amount of the newly synthesized proteoglycan, similar in molecular weight to the original, had recovered to about half that of the original, although the new proteoglycan fraction was rich in hyaluronic acid. It was concluded that, following chemonucleolysis with chymopapain, the water-binding capacity of the nucleus pulposus recovered, but that the regenerated nucleus pulposus differed biochemically from the original.