Cervical Myelopathy Possibly Induced by Intraoperative Posture During Robot-Assisted Radical Prostatectomy

A lithotomy position is a standardized posture during robot-assisted radical prostatectomy, and several intraoperative complications related to this position have been described. However, cervical myelopathy possibly induced by this position during robot-assisted radical prostatectomy is seldom reported. A 69-year-old man presented to the department of neurosurgery, complaining of sensory disturbance and motor weakness in the lower bilateral extremities. The patient underwent a robotic-assisted radical prostatectomy one month before. The patient was set in a lithotomy position for 4 hours and 25 minutes. Approximately two weeks after surgery, neurological deficits appeared and aggravated chronologically (finally equivalent to a Manual Muscle Testing of 1). The patient had not experienced any similar symptoms before prostatectomy. A blood examination was not suggestive of any inflammatory diseases. Cervical degenerative spondylosis was identified on whole spine magnetic resonance images. We considered that his neurological symptoms could be cervical myelopathy, possibly triggered by the lithotomy position during prostatectomy, because the posture and weight burden could have compressed the spinal cord. Cervical laminoplasty from C3 to C6 was performed to decompress the spinal cord. Two months after cervical laminoplasty, the motor weakness in the lower extremities recovered gradually, equivalent to a Manual Muscle Testing of 4, with rehabilitation therapy. After discharge from the hospital, the patient continues home visiting rehabilitation five months after surgery. Cervical myelopathy may result from the lithotomy position during robot-assisted radical prostatectomy. Clinicians should be aware of this rare complication related to the intraprocedural posture in the urological field. Similar cases seem to be warranted to elucidate the mechanism of this rare postoperative complication.