A case report of pulmonary embolism following endoscopic cervical discectomy in an elderly patient with cervical disc herniation
Shangchen Yu, Zheng Li, Shuguang Yang, Chao Chen, Kun Chen, Man Shi, Haiting Wang, Siqi Zhou, Wen Zhang, Xuebi TianRationale:
Posterior percutaneous endoscopic cervical discectomy (P-PECD) is a minimally invasive procedure for cervical spine disorders. Although it is associated with less surgical trauma and faster postoperative recovery, serious perioperative thromboembolic complications may still occur.
Patient concerns:
A 65-year-old woman with cervical disc herniation, right upper limb pain, and multiple comorbidities underwent posterior percutaneous endoscopic cervical discectomy after unsuccessful conservative treatment. On the 2nd postoperative day, she developed dizziness and decreased oxygen saturation. On the 3rd postoperative day, she complained of chest tightness.
Diagnoses:
Laboratory testing revealed a markedly elevated plasma D-dimer level. Venous color Doppler ultrasound of both lower limbs demonstrated thrombosis in the bilateral calf muscular veins, and computed tomography pulmonary angiography confirmed multiple pulmonary emboli.
Interventions:
The patient received oxygen therapy, continuous cardiorespiratory monitoring, anticoagulation with low-molecular-weight heparin, and other supportive treatments. She was transferred to the intensive care unit for further monitoring and management.
Outcomes:
The patient’s respiratory and circulatory status gradually stabilized, and her chest tightness and dizziness resolved. She was subsequently transferred back to the pain ward and discharged in stable condition.
Lessons:
This case highlights that minimally invasive spinal surgery does not eliminate the risk of perioperative venous thromboembolism. Comprehensive preoperative thrombotic risk assessment, individualized perioperative management of antithrombotic therapy, appropriate thromboprophylaxis, early mobilization, and timely recognition and treatment of suspected APE are important for improving perioperative safety.