Fatal Spinal Cord Edema Following Cervical Decompression Surgery Possibly Associated with Dialysis Disequilibrium Syndrome: A Case Report

Dialysis disequilibrium syndrome (DDS) is a rare neurological complication of hemodialysis caused by rapid osmotic shifts. While its cerebral effects are well recognized, its impact on the spinal cord has not been well documented. We report the fatal case of a 57-year-old man on maintenance hemodialysis who developed progressive spinal cord edema 15 days after posterior cervical decompression surgery. The patient's neurological deterioration occurred in temporal association with each hemodialysis session, during which the patient exhibited significant fluctuations in blood urea nitrogen (pre-dialysis range: 54.8-122.9 mg/dL). Despite aggressive management, including extended dialysis and continuous renal replacement therapy, his condition worsened. Autopsy revealed extensive spinal cord necrosis at the surgical site, with findings consistent with severe, recurrent edema and its compressive effects, without evidence of a primary ischemic or inflammatory pathology. This case suggests a devastating, atypical manifestation of a DDS-like pathophysiology, where the surgically compromised spinal cord may have become a vulnerable target for osmotic shifts, underscoring the need for a high index of suspicion in post-neurosurgical patients undergoing hemodialysis.