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Cervical Spinal Cord Injury During Prone Position Ventilation in the COVID-19 Pandemic
Abdulrahman M AlMutiri1, Samer Alsulaimani2, Abdulrahman J Sabbagh1
1Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU.
Cureus
|October 28, 2021
Summary
Prone positioning in intensive care can cause spinal cord injury in COVID-19 patients with underlying cervical spine issues. Early X-ray screening is recommended to prevent fractures and neurological damage.
Area of Science:
- Neurology
- Critical Care Medicine
- Radiology
Background:
- Prone positioning improves oxygenation in severe COVID-19 patients with Acute Respiratory Distress Syndrome (ARDS).
- Prolonged prone ventilation in intensive care units (ICUs) may lead to complications.
- Severe COVID-19 (caused by SARS-CoV-2) often requires mechanical ventilation and intensive care.
Observation:
- A 45-year-old female with severe COVID-19-related hypoxemia required prolonged prone ventilation.
- She developed a decreased level of consciousness and quadriparesis.
- Cervical spine imaging revealed C4/C5 fracture-dislocation with spinal cord compression, associated with asymptomatic ankylosing spondylitis and ossification of the posterior longitudinal ligament.
Findings:
- The patient's condition was complicated by hemodynamic instability and severe ARDS.
- Surgical intervention was not feasible due to her critical state.
- She ultimately died from multi-organ failure.
Implications:
- This case highlights the risk of spontaneous cervical spine fracture-dislocation and spinal cord injury in COVID-19 patients undergoing prolonged prone ventilation.
- Underlying cervical spine abnormalities may predispose patients to hyperextension-related stress fractures.
- Routine cervical spine screening with X-rays is crucial for early detection of potential issues in patients requiring prone positioning.
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