Ischemic spinal cord syndrome after transthoracic esophagectomy: two casesof a rare neurologic complication

Anterior spinal artery syndrome (ASAS) is a rare complication after surgery of the thoracic or abdominal aorta. The sulco commissuralis syndrome repre sents a partial or incomplete ASAS. We report two cases of ischemic spinal cord syndromes after transthoracic esophagectomy. This represents a prevale nce of this syndrome of 0.2% in more than 1000 consecutive esophagectomies performed at our institution. Patient 1 developed an ASAS on the first day after esophagectomy. Patient 2 showed the pathognomonic clinical signs asso ciated with sulco commissuralis syndrome after an asymptomatic window. In b oth patients, the extent of the neurologic symptoms initially improved but then remained unchanged for the rest of the follow-up of 9 and 12 months. A lthough the prognosis of neurologic syndromes resulting from spinal cord in farction is poor, preoperative tests to identify patients at risk appear no t to be justified because of the very low incidence of these syndromes afte r esophagectomy and the poor sensitivity and specificity of currently avail able diagnostic modalities. However, the possibility of ischemic spinal cor d syndrome should be kept in mind when patients present with neurologic sym ptoms after esophagectomy.