The Journal of Bone and Joint Surgery

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A Complication of Anterior Spinal Instrumentation

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A seventy-four-year-old woman was first seen because of a two-month history of back pain following a motor-vehicle accident. The patient reported that the pain had been increasing during the previous two weeks and that there was progressive weakness of the lower extremities. Neurological examination revealed a symmetrical decrease in the strength of the muscles of the lower extremities. There was a sensory loss distal to the inguinal level. A magnetic resonance imaging scan was performed.

What is the diagnosis?

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On the third postoperative day, signs of cardiac and respiratory distress were noted. The patient had a pulse rate of 130 beats per minute, a respiratory rate of thirty-two breaths per minute, and a blood pressure of 70/50 millimeters of mercury (9.33/6.67 kilopascals). A stable hemodynamic status could not be achieved despite the administration of four units of whole blood and 1500 milliliters of Ringer's lactate solution through a central venous line. A radiograph of the chest was performed.

What is the diagnosis?