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Final Program


Final Program

879 - Take a Deep Breath: An unusual case of spinal cord ischemia during a bilateral lung transplant

Thursday, February 27, 2025
5:00 PM - 6:30 PM MST
Case Diagnosis: This case report demonstrates the unique pulmonary challenges of a 59 year-old gentleman with post-COVID Interstitial Lung disease who developed anterior cord syndrome during his bilateral lung transplant surgery.  

Case Description: He underwent a bilateral lung transplantation with no intra-operative complications. However, he awoke from sedation with paraplegia. Imaging noted an anterior spinal cord infarct at T3. He had a prolonged hospital course and subsequent inpatient rehabilitation course due to pulmonary difficulties unique to his case. The patient continued to have hypoxic respiratory failure but also hypercapnic respiratory failure and frequent mucus plugging. 

Discussions:

A less common watershed area in the thoracic spine is between T3-T7 which receives blood supply from the intercostal arteries.  After significant internal review of the patient case, it was suspected that an emboli (possibly atherosclerotic) occurred during the surgery as the clamshell thoracosternotomy incision was at the 4th intercostal space. The patient had a history of non-obstructive CAD and noted atherosclerotic plaques in his carotids during his transplant work-up.    



He required more aggressive pulmonary toileting due to weakness of intercostal and abdominal muscles expounded by his paraplegia.   A combination of tools were utilized for adequate ventilation.  He received cough assist and chest wall percussion by respiratory therapists and also more frequent bronchoscopies with the pulmonology to monitor lung functioning.  Early and frequent mobilization with therapists also helped to improve his ventilation. 


Conclusions: Rehabilitation for anterior cord syndrome from spinal cord ischemia is not unique, nor is rehabilitation after a bilateral lung transplant.  However, there are no cases in the literature of a patient sustaining spinal cord ischemia after a bilateral lung transplant and the pulmonary difficulties faced.  For this person, truly aggressive pulmonary toileting was needed. and “routine” SCI care (cough assist, chest percussion, transfer training, and sitting tolerance) also aided for improved lung function.