Anterior Spinal Artery Syndrome following Splanchnic Nerve Cryoablation for Oncological Pain: A Case Report

Anterior spinal artery syndrome is a diagnosis associated with high morbidity, mortality, and long-term disability. It is a known complication following conventional celiac plexus and splanchnic nerve blocks. The popularity of minimally invasive pain procedures is growing, especially in the domain of oncology, and the interventions are being performed by specialists with varying backgrounds. Complications such as anterior spinal artery syndrome need to be at the forefront of specialists' minds whenever there is manipulation of the celiac plexus or splanchnic nerves. These structures play an integral role in maintaining circulatory perfusion. The earlier hypoperfusion is suspected or confirmed, the better the prognosis, as steps can be taken to immediately correct this deficit.

We present a case of a 65-year-old man with a history of poorly differentiated metastatic pancreatic adenocarcinoma who suffered a thoracic anterior spinal artery infarction following a splanchnic nerve cryoablation. Noninvasive methods to control pain prior to the procedure were unsuccessful. Prior to becoming a paraplegic this patient was independent in all activities of daily living and ambulation.

This case report aims to prove the importance of being familiar with the early signs associated with spinal cord infarction and the importance of completing a thorough, transparent informed consent process when manipulating the celiac plexus or splanchnic nerves. Cryoablation procedures of such structures remain relatively novel compared to conventional blocks. Few case reports have documented anterior spinal artery syndrome following cryoablation. This unfortunate complication results in permanent, life-altering damage. We also propose steps that can be taken to minimize this risk.