SCI
Jeremy K. Fagan, MD, PhD
Resident Physician
University of Cincinnati
Cincinatti, Ohio, United States
Danielle Shoreman, MD
Assistant Professor
University of Cincinnati
Cincinatti, Ohio, United States
Jeremy K. Fagan, MD
University of Cincinnati
Cincinatti, Ohio, United States
Abdominal Compartment Syndrome, Incomplete Thoracic Myelopathy, Spinal Cord Injury, Consultation Service
Case Description:
An 80-year-old woman with a recent diagnosis of multiple myeloma, now one month status post T5–T9 posterior decompression and instrumented fusion with T7 corpectomy and tumor resection, presented to the ED from home with worsening thoracic back pain, severe constipation, and poor oral intake. She reported an absence of bowel movements for the past four days and persistent pain without meaningful relief since her recent surgery.
She was admitted to the Hematology/Oncology service, where the PM&R consult team was engaged for evaluation of ongoing spinal cord injury, optimization of bladder and bowel management, and assessment of rehabilitation potential. On examination, she demonstrated marked abdominal rigidity, ongoing lower back pain, and increased work of breathing. A stat KUB was obtained, and an aggressive bowel regimen was initiated. Within hours, the patient developed acute encephalopathy with diminished responsiveness, necessitating endotracheal intubation and transfer to the medical intensive care unit for higher-level care.
Discussions: This case is notable given that abdominal compartment syndrome represents a rare yet life-threatening complication of posterior spinal fusion surgery, associated with a high mortality rate. Early involvement of a Physical Medicine and Rehabilitation consultation service, in close collaboration with the surgical teams and nursing staff, can be essential in ensuring comprehensive management and coordination of care throughout the patient’s recovery following spinal cord injury.
Conclusions: Given the complexities inherent to spinal surgical interventions that place patients at risk for spinal cord injury, early involvement of PM&R prior to surgery is critical in mitigating adverse outcomes such as autonomic complications. Proactive PM&R consultation allows for optimization of bladder and bowel function, careful monitoring of physiologic stability, and seamless coordination of the transition to inpatient rehabilitation, where close surveillance and comprehensive management of complex care needs can be provided
