Anesthetic considerations in a patient with cervical spine surgery history undergoing laparoscopic cholecystectomy

This case report presents the anesthesiological management of a 68-year-old male patient
undergoing laparoscopic cholecystectomy for recurrent acute cholecystitis. The patient has a
significant surgical history, including a cervical spine operation in 2022, following a diagnosis of
quadriparesis, spinal stenosis (C4-C5), and polydiscopathy of the cervical region. The previous
surgery involved anterior decompression, C5 corpectomy, C4 hemicorpectomy and
hemiforaminectomy, transpedicular fixation from C4-C6, and the application of a MESH. Despite
the successful operation, the patient continued to experience paresthesia in both the upper and
lower extremities, requiring the use of crutches for mobility. A subsequent neck x-ray revealed
ventral marginal osteophytes of the cervical vertebral bodies.
Given the patient's cervical spine pathology and residual neurological deficits, particular caution
was necessary during the anesthesiological evaluation and planning for intubation. The patient
had a Mallampati score of 2, a thyromental distance greater than 6 cm, and no significant dental
abnormalities. Neck mobility was preserved, and there were no additional contraindications for
standard intubation techniques. However, the residual paresthesia and history of spinal surgery
warranted close monitoring and careful positioning during anesthesia to avoid potential spinal
cord or nerve impingement.
This case underscores the importance of thorough preoperative assessment and tailored
anesthesiological strategies in patients with complex spinal histories, particularly when surgical
procedures are being performed in anatomically and neurologically sensitive regions