Refractory Orthostatic Hypotension After Cervical Laminoplasty: A Case Report

Abstract

We report a case of postoperative orthostatic hypotension (OH) after cervical laminoplasty for central cord syndrome (CCS). A 76-year-old man with a history of glaucoma sustained a fall and developed incomplete tetraparesis. Magnetic resonance imaging revealed severe cervical stenosis (C2-4 and C4-6) with intramedullary T2 hyperintensity, leading to a diagnosis of cervical compressive myelopathy. After initial conservative management and rehabilitation, where blood pressure remained stable (mean systolic blood pressure 127 mmHg, diastolic blood pressure 64 mmHg), he underwent C3-6 laminoplasty on day 41 from onset. From postoperative day 2, he experienced recurrent dizziness and transient loss of consciousness associated with significant systolic blood pressure drops (≥20 mmHg) during postural changes, confirming a diagnosis of OH. Despite comprehensive nonpharmacological interventions, including compression stockings, gradual orthostatic training with a tilt table, and recumbent bicycle exercise, his OH persisted, characterized by consistently low blood pressure during rehabilitation. Although no syncopal episodes occurred, the OH was considered refractory and lasted until discharge approximately seven months later. This case highlights that postoperative OH can be a significant and refractory complication in elderly patients with cervical compressive myelopathy after cervical laminoplasty, even with standard nonpharmacological rehabilitation. Increased awareness of this complication is crucial, and further research is needed to elucidate its underlying mechanisms and develop more effective management strategies.