Brachial Plexus Injury Due to Central-line Insertion During Kypho-scoliosis Deformity Correction

Overview

Journal J Orthop Case Rep

Specialty Orthopedics

Date 2021 Nov 18

PMID 34790601

Authors

Hitesh N Modi

Shakti A Goel

Arvind Sharma

Udit Patel

Affiliations

Soon will be listed here.

Abstract

Introduction: Internal Jugular Venous (IJV) cannulation or central-line insertion is frequently performed during kyphoscoliosis deformity correction surgery or spine surgery with high risk. This helps monitor central venous pressure and administer medicines when required. Although many complications of IJV cannulation have been reported in the literature, its effect on brachial plexus is not known. The objective of this paper was to report a rare complication of IJV during scoliosis surgery.

Case Presentation: We reported a case of 27-year-old male who was operated for severe kyphoscoliosis correction where preoperatively IJV cannulation was done. Repeated attempts were done during IJV cannula insertion due to altered anatomy. Eventually, cannula insertion was done using ultrasound modality and surgery for correction was done. Postoperatively patient developed right upper extremity weakness and sensory loss although the clinical result of kyphoscoliosis correction was acceptable. EMG-NCV study proved it brachial plexus injury. The patient was treated with intravenous steroid and physiotherapy. The patient recovered completely within 6 months of surgery.

Conclusion: We reported a case of kyphoscoliosis deformity corrective surgery where IJV cannulation led to brachial plexus injury and was eventually recovered with medications and physiotherapy.

References

Briscoe C, Bushman J, McDonald W . Extensive neurological damage after cannulation of internal jugular vein. Br Med J. 1974; 1(5903):314. PMC: 1633355. DOI: 10.1136/bmj.1.5903.314. View

Ferrero-Manzanal F, Lax-Perez R, Lopez-Bernabe R, Betancourt-Bastidas J, Iniguez de Onzono-Perez A . Traction injury of the brachial plexus confused with nerve injury due to interscalene brachial block: A case report. Int J Surg Case Rep. 2016; 27:78-82. PMC: 4995386. DOI: 10.1016/j.ijscr.2016.08.023. View

Tan J, Liu L, Xie J, Hu L, Yang Q, Wang H . Cost-effectiveness analysis of ultrasound-guided Seldinger peripherally inserted central catheters (PICC). Springerplus. 2016; 5(1):2051. PMC: 5130933. DOI: 10.1186/s40064-016-3698-8. View

Jung C, Jalilov G, Song I, Kim E, Kim H, Kim J . Position and relative size of the vertebral artery according to age: Implications for internal jugular vein access. Paediatr Anaesth. 2017; 27(10):997-1002. DOI: 10.1111/pan.13209. View

Keenan S . Use of ultrasound to place central lines. J Crit Care. 2002; 17(2):126-37. DOI: 10.1053/jcrc.2002.34364. View

Kollar G, Alizadeh H, Gulyas E . [Nurse style of central vein! Our experience in the peripherally inserted central venous catheter]. Orv Hetil. 2017; 158(22):856-863. DOI: 10.1556/650.2017.30765. View

Akaraborworn O . A review in emergency central venous catheterization. Chin J Traumatol. 2017; 20(3):137-140. PMC: 5473741. DOI: 10.1016/j.cjtee.2017.03.003. View

Mohan V, Nisa N . Importance of Sonography for Guiding Central Venous Cannulation in Patients with Neurofibromatosis. Turk J Anaesthesiol Reanim. 2017; 45(3):169-171. PMC: 5512396. DOI: 10.5152/TJAR.2017.92259. View

Yuan K, Liu E, Li P, Shangguan W, Li J, Lian Q . Anatomic variations of neck vessels and the course of pediatric internal jugular veins. Paediatr Anaesth. 2017; 27(10):1003-1009. DOI: 10.1111/pan.13211. View

10.

Nowak L, Duda K, Mizianty M, Wilczek M, Bieda T . Horner syndrome after unsuccessful venous port implantation by cannulation of the right internal jugular vein. Anaesthesiol Intensive Ther. 2015; 47(4):336-8. DOI: 10.5603/AIT.2015.0049. View

11.

Vaish A, Ahmed S, Shetty A . Remote physiotherapy monitoring using the novel D+R Therapy iPhone application. J Clin Orthop Trauma. 2017; 8(1):21-24. PMC: 5359516. DOI: 10.1016/j.jcot.2016.08.008. View

12.

Chan A, Parent E, Narvacan K, San C, Lou E . Intraoperative image guidance compared with free-hand methods in adolescent idiopathic scoliosis posterior spinal surgery: a systematic review on screw-related complications and breach rates. Spine J. 2017; 17(9):1215-1229. DOI: 10.1016/j.spinee.2017.04.001. View

13.

Hickey C, Gugino L, Aglio L, Mark J, Son S, Maddi R . Intraoperative somatosensory evoked potential monitoring predicts peripheral nerve injury during cardiac surgery. Anesthesiology. 1993; 78(1):29-35. DOI: 10.1097/00000542-199301000-00006. View

14.

Warner M, Warner M, Martin J . Ulnar neuropathy. Incidence, outcome, and risk factors in sedated or anesthetized patients. Anesthesiology. 1994; 81(6):1332-40. View

15.

Labrom R, Hoskins M, Reilly C, Tredwell S, Wong P . Clinical usefulness of somatosensory evoked potentials for detection of brachial plexopathy secondary to malpositioning in scoliosis surgery. Spine (Phila Pa 1976). 2005; 30(18):2089-93. DOI: 10.1097/01.brs.0000179305.89193.46. View