Tapia's Syndrome after Posterior Cervical Spine Surgery under General Anesthesia
The patient of first case is a 53-year-old man who presented right shoulder drop and right shoulder pain. On motor examination, weakness of 0/5 right in shoulder abduction was found. Magnetic resonance imaging revealed C4/5 foraminal herniated nucleus pulposus (). The patient was placed in the concord position under general endotracheal anesthesia and the head was secured in the Mayfield head clamp. The patient underwent a posterior foraminotomy with discectomy. Immediate postoperatively, weakness of right shoulder abduction was improved from 0/5 to 3/5. On postoperative day 1, he complained of hoarseness, hypesthesia of left side tongue, buccal cavity and deviation of the tongue to the left during protrusion. There was no definitive lesion in postoperative brain magnetic resonance imaging. In laryngeal electromyography with 37 mm monopolar needle, there was no motor unit action potential on left thyroarytenoid muscle which is innervated by the recurrent laryngeal branch of the vagus nerve. Six months after surgery, symptoms were resolved.\nThe patient of second case is a 56-year-old man who presented gait disturbance. Fifteen years prior to admission, he had a cervical injury from a traffic accident and underwent C5/6 anterior cervical discectomy and fusion. On neurologic examination, ankle clonus was found. Magnetic resonance imaging and computed tomography revealed spinal stenosis on C2/3/4/5 and ossified yellow ligament in right C2/3 (). The patient was placed in the concord position under general endotracheal anesthesia and the head was secured in the Mayfield head clamp. He underwent right C2 hemilaminectomy and C3/4/5 laminoplasty under general anesthesia. Surgery was uneventful. Postoperatively, he complained of hoarseness, hypesthesia of left side tongue, and deviation of the tongue to the left during protrusion. On postoperative day 4, all symptoms except hoarseness were resolved. Two months later, hoarseness was also completely resolved.