943 日本臨床麻酔学会症例報告 日臨麻会誌 Vol.32 No.7, 943 947, 2012 頚椎後方手術後に脳神経麻痺による嚥下障害を生じた 3 症例 *1 平山三智子 *2 西川光一 [ 要旨 ] 頚椎後方手術後に, 脳神経麻痺による嚥下および構音障害を生じた 3 症例を経験した.3 症例とも術後に舌偏位が認められ, 末梢性の舌下神経麻痺と診断された.1 症例のみ迷走神経麻痺によるカーテン徴候を合併していた. 嚥下および構音障害は術後 2 週間から3ヵ月間に改善し, 以降も良好に経過している. 脳神経麻痺の原因には, 舌下, 迷走神経を栄養する上行咽頭動脈の挿管チューブによる血流障害, 術操作による直接障害, 頚部の牽引に伴う神経の伸展による障害が疑われた. 頚椎後方手術後の脳神経麻痺の発生はまれであるが, 術後の嚥下障害や構音障害の原因となることを医療従事者が十分認識し, 誤嚥の予防に取り組むことが必要である. キーワード : 合併症, 嚥下障害, 構音障害, 舌下神経麻痺, 迷走神経麻痺 はじめに 3 54 1 3 0.84 1.87 2, 3 4 3 Ⅰ 症例 1 80 148cm 45kg 62 1 C2-C4 T11-T12 TCI target controlled infusion 3 g/ml 0.1 g/kg/min 5mg HOYA- 2.0 3.0 g/ml 0.05 0.15 g/kg/ min 3 40 4 39 1 1 2012. 5. 1. 2012. 7. 8. 2 649-7113 219
944 Vol.32 No.7/Nov. 2012 図 1 症例 1 の症状 4 MRI CT 9 図 1 1 3 2 49 173cm 76kg 6 1 C3-C6 C4/5 C5/6 150mg 50mg 20mg 1.5 2.5 3 14 4 21 1 1cm 1 MRI CT 3 9 1 2 6 3 66 163cm 68kg 51 46 C3-C7 150mg 50mg 0.3 g/kg/min 15mg 1.2 1.5 0.05 0.25 g/kg/min 2 38 3 28
945 MRI CT 5 2 Ⅱ 考察 Hong C1-C2 5 3 Bekelis 6 1 7, 8 1904 Antonio Garcia Tapia Tapia Tapia Tapia 9, 10 2 Tapia 25cmH 2 O Tapia Hong C1-C2 6 2
946 Vol.32 No.7/Nov. 2012 5 Bekelis C1-C3 1 6 3 2 3 20 参考文献 1) Lee MJ, Bazaz R, Furey CG, et al.:risk factors for dysphagia after anterior cervical spine surgery:a two-year prospective cohort study. Spine J 7:141-147, 2007 2) Shamji MF, Cook C, Pietrobon R, et al.:impact of surgical approach on complications and resource utilization of cervical spine fusion:a nationwide perspective to the surgical treatment of diffuse cervical spondylosis. Spine J 9:31-38, 2009 3) Boakye M, Patil CG, Santarelli J, et al.:cervical spondylotic myelopathy:complications and outcomes after spinal fusion. Neurosurgery 62:455-462, 2008 4) Smith-Hammond CA, New KC, Pietrobon R, et al.:prospective analysis of incidence and risk factors of dysphagia in spine surgery patients:comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine 29:1441-1446, 2004 5) Hong JT, Lee SW, Son BC, et al.:hypoglossal nerve palsy after posterior screw placement on the C-1 lateral mass. Case report. J Neurosurg Spine 5:83-85, 2006 6) Bekelis K, Gottfried ON, Wolinsky JP, et al.:severe dysphagia secondary to posterior C1-C3 instrumentation in a patient with atlantoaxial traumatic injury:a case report and review of the literature. Dysphagia 25:156-160, 2010 7) Ginsburg GM, Bassett GS:Hypoglossal nerve injury caused by halo-suspension traction. A case report. Spine 23:1490-1493, 1998 8) Telfer RB, Hoyt WF, Schwartz HS:Crossed eyes and halo-pelvic traction. Lancet 2:922-923, 1971 9) Boisseau N, Rabarijaona H, Grimaud D, et al.:tapia s syndrome following shoulder surgery. Br J Anaesth 88:869-870, 2002 10)Cinar SO, Seven H, Cinar U, et al.:isolated bilateral paralysis of the hypoglossal and recurrent laryngeal nerves(bilateral Tapia s syndrome)after transoral intubation for general anesthesia. Acta Anaesthesiol Scand 49:98-99, 2005
947 Three Cases of Dysphagia after Posterior Cervical Spine Surgery Secondary to Cranial Nerve Palsy Michiko HIRAYAMA *1, Koichi NISHIKAWA *2 *1 Department of Anesthesiology, Wakayama Medical University Kihoku Hospital *2 Department of Anesthesiology, Wakayama Medical University Dysphagia is well recognized as a complication of anterior cervical spine surgery. On the other hand, there are only a few reports of dysphagia in patients who underwent posterior cervical spine surgery. We report three cases who developed dysphagia and dysarthria, possibly secondary to cranial nerve palsy. These patients, who were scheduled for posterior cervical laminoplasty, were managed with general anesthesia in the prone position. Postoperatively, they were found to have dysphagia and dysarthria. Cranial MRI assessments of these patients showed no abnormality. We concluded that these patients were suffering from peripheral hypoglossal and vagal nerve palsy. This nerve damage could have been caused by extension due to wound retractor, ischemia of nutrient artery, and/or stretching with hyperextension of the neck. These neurogenic disorders recovered completely from 2 weeks to 3 months postoperatively. Anesthesiologists should be aware that such complications may occur during posterior cervical spine surgery and that evaluating swallowing function preoperatively and postoperatively is very important. Key Words : Complication, Dysphagia, Hypoglossal nerve palsy, Vagal nerve palsy, Posterior spine surgery The Journal of Japan Society for Clinical Anesthesia Vol.32 No.7, 2012