Post-operative quadriparesis following posterior cervical laminectomy and fusion: A case-series of incidence, risk factors, and management.

Objective: Post-operative quadriparesis following posterior cervical decompression and fusion is a rare but devastating complication. Unless rapidly identified and treated, it can cause permanent injury and disability. Given the sparse literature on this topic we intend to report on its incidence, to identify potential predisposing risk factors, and to discuss management considerations.

Methods: We retrospectively reviewed a series of 301 patients who underwent posterior cervical decompressive laminectomies and instrumented fusion performed by the senior author between 2006 and 2020. We describe the clinical courses and interventions for the seven of these 301 patients who developed post-operative quadriparesis.

Results: The incidence of post-operative quadriparesis following cervical spine decompressive laminectomies and instrumented fusion was 2.3% (7/301) in our study. The mean time-to-onset was 2 days, and the most common pathology was post-operative hematoma. We did not identify any statistically significant risk factors that predispose patients to post-operative quadriparesis. In our series, the patients with post-operative quadriparesis without profound hypotension who underwent emergent surgical decompression demonstrated improved neurologic outcomes compared to those who underwent interval imaging prior to decompression.

Conclusion: Post-operative quadriparesis following cervical spine surgery is a catastrophic complication that is poorly reported and under-studied in current literature. In this study, we found a 2.3% incidence of post-operative quadriparesis with no obvious risk factors predisposing patients to this adverse outcome. We advocate that post-operative quadriparesis following cervical spine surgery, in the absence of profound hypotension, warrants emergent surgical site exploration without delay for interval imaging.