Acute Paraplegia Following Spinal Anesthesia in a Patient With Unrecognized Thoracic Ossification of the Posterior Longitudinal Ligament and Spinal Stenosis: A Case Report

Spinal coning is a rare complication in spinal anesthesia that results in acute neurological deterioration. It occurs when a pre-existing spinal stenosis alters the CSF flow, creating a high-pressure area beneath the stenosis. The introduction of a needle into this relatively high-pressure area would cause a decrease in CSF pressure, exacerbating the spinal cord compression. This article reports a 50-year-old female who presented with urinary frequency for six months and was diagnosed with urethra spasm. Following spinal anesthesia, a botulinum toxin injection over the urethra was performed by a urologist. The patient did not recover from the anesthesia, which subsequently resulted in acute paraplegia status with bowel and bladder dysfunction. An MRI of her thoracic spine revealed ossification of the posterior longitudinal ligament with severe spinal stenosis. She received decompressive surgery and recovered well. Surgeons and anesthesiologists should be aware of patients who may have pre-existing spinal stenosis to avoid the use of spinal anesthesia and thus prevent spinal coning. Rapid neurological deterioration and severe disability warrant early aggressive surgical treatment for better recovery.