A case of Acute C5 – C6 Compressive myelopathy with bowel involvement  

Jenma Rakkini1*, Subathra Devi. M2, Maha Lakshmi3

1Nursing Supervisor, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

2Nurse Educator Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

*Correspondence

Abstract

A male patient presented with sudden neck pain followed by weakness in both upper and lower limbs. He was unable to walk, with no sensory loss. Surgery was uneventful, and he was stable after shifting to the ward. However, on 28/01/2026, he developed blood-stained sputum, low oxygen saturation, and bradycardia, leading to cardiac arrest. CPR was started immediately. He was later shifted to the Neuro ICU, intubated, and managed with ventilator support, Noradrenaline, and sedation.  But he had a very adverse outcome.

Key words: Blood-stained sputum; Bradycardia; Acute C5 – C6 Compressive myelopathy

Introduction

Sudden neck pain with weakness in all limbs is a serious condition that needs early treatment. Patients can develop sudden complications after surgery, such as breathing problems or cardiac arrest. Close monitoring and immediate management are important to avoid such catastrophes. 

Case Presentation

A 39-year-old male patient presented with a history of sudden onset neck pain for one day. Following the neck pain, he developed weakness in both upper and lower limbs, and was unable to walk, and could not get up from bed. There was no sensory disturbance in his upper or lower limbs. He had bowel disturbance in the form of constipation for 3 days. There was no history of trauma, fall, giddiness, or slurring of speech. 

Social History: He does not have any social history of cigarette smoking and alcohol addiction.

Allergies: Not a known medicine

Past Medical History: Nil

Past Surgical history: Nil

Vitals on Examinations

Blood pressure120/70 mmHg
Heart rate98 beats/min
Respiratory rate22 breaths/min
Oxygen saturation98% on room air
Temperature98.7°F
GCSE4 V5 M6, Bilateral pupils reacting to light

Upper limb

  • Proximal – 4/5
  • Distal -3/5

Lower limb

  • Proximal 4/5
  • Distal 4/5
  • Bilateral EHL weakness present

Deep tendon reflexes: Upper limb all exaggerated

Relevant Investigation

DateParameterResult
26/01/2026Blood Group and Rh Type - AutomatedB Positive
Chloride99 mmol/L
Creatinine0.9 mg/dL
Urea Serum30 mg/dL
Creatine Phosphokinase (CPK)93 U/L
Magnesium2.38 mg/dL
Sodium138 mmol/L
Bicarbonate26 mEq/L
Phosphorous3.3 mg/dL
Potassium3.9 mmol/L
Mean Corpuscular Haemoglobin Concentration 32.5 g/dl
Haemoglobin15.5 g/dl
Packed Cell Volume (PCV)47.70%
Absolute Eosinophil Count (AEC)0 cells/µl
Absolute Lymphocyte Count (ALC)2360 cells/µl
Basophil0.10 %
Absolute Monocyte Count (AMC)330 cells/µl
Control (APTT)27.0 Seconds
Control (PT)11.7 Seconds
Test (APTT)25.1 Seconds
Test (PT)11.3 Seconds
Absolute Neutrophil Count (ANC)13560 cells/µl
Neutrophil83.40%
Monocyte2.00%
Mean Platelet Volume9.2 NA
Platelet Count346000 cells/µl
Total WBC Count16270 Cells/Cumm
Mean Corpuscular Volume (MCV)80.2
Mean Corpuscular Haemoglobin26.1 pg/cell
Hepatitis B Surface Antigen (HBsAg)Negative (0.08)
Hepatitis C Antibody (Anti HCV)Non-Reactive (0.01)
27/01/2026Total Thyroxine (T4)4.04 µg/dL
Total Triiodothyronine (T3)0.45 ng/mL
Thyroid Stimulating Hormone (TSH)1.882 mIu/l
28/01/2026Haematocrit44%
Haematocrit34%
Lymphocyte7.60%
Mean Corpuscular Haemoglobin Concentration 32.7 g/dl
Haemoglobin13.0 g/dl
29/01/2026Creatinine0.7 mg/dL
Urea Serum40 mg/dL
Calcium Free Ionized4.35 mg/dL
30/01/2026Procalcitonin0.692 ng/mL
C Reactive Protein (CRP)39.8 mg/L
02/02/2026Magnesium1.94 mg/dL
Urea Serum35 mg/dL
Sodium136 mmol/L
Creatinine0.7 mg/dL
Phosphorous2.8 mg/dL
Calcium Serum8.5 mg/dL
Potassium4.1 mmol/L
Glucose In Glucometer POCT134 mg/dL

Ultrasonogram neck (28.01.2026)

Focal heterogenous collection in right side of neck lateral to right lobe of thyroid -likely haematoma.

Multislice CT Scan Neck Plain Study (29.01.2026)

  • Post anterior cervical discectomy status at C5-C6 level.
  • Poorly defined hyper dense non-enhancing lesion in the prevertebral space causing mass effect with no active contrast leak

Multislice CT scan brain plain study (29.01.2026): Diffuse cerebral edema.

Multislice CT scan chest plain study (29.01.2026)

  • Patchy peri bronchial and peripheral consolidation in dependant segments of right upper and bilateral lower lobes.
  • Subsegmental atelectasis in right upper lobe.
  • No significant mediastinal lymphadenopathy.

Diagnosis

Acute C5 – C6 compressive myelopathy with bowel involvement

Surgery notes

  • On 27.01.2026: Anterior cervical decompression – C5 – C6 level done under general anaesthesia
  • On 29.01.2026: Re-exploration and evacuation and post ACD hematoma done under general anaesthesia
Implant nameBatch number
C Age Octa Peek Cervical Interbody Titanium 4.5 Mm Gesco047228012026/10028914
M Microscope Cover Smart drape 306028-0000-000 Zeiss49905012026 /10028598

Management

The intra-operative period was uneventful, and the patient was shifted to the post-operative ward. In the ward, he was observed for 4 hours. He remained conscious, oriented, and was able to speak well. Oral liquids were started, and he tolerated them without any aspiration or breathing difficulty.

On 28/01/2026, while in the ward, the patient developed a bout of cough with blood-stained sputum at around 7:00 AM. By 7:30 AM, he developed desaturation (SpO₂ 88%) along with bradycardia. The anaesthetist was informed immediately. The patient then went into cardiac arrest, and CPR was initiated as per ACLS protocol. Due to difficult intubation, a laryngeal mask airway (LMA) was secured.

The patient was then shifted to the Neuro ICU. In the ICU, he was re-intubated with an endotracheal tube and placed on ventilator support. His blood pressure was 80/50 mmHg, and SpO₂ was maintained at 100% with ventilation. A noradrenaline infusion was started to manage hypotension. The patient was sedated and paralysed for further management.

Out come

Post cardiac arrest status

Hypoxic ischaemic encephalopathy secondary to laryngeal edema

Cause of Death 

Immediate cause: Hypoxic ischaemic encephalopathy

Antecedent cause: Cardiac arrest, secondary Anterior cervical decompression – c5 -c6, Post cardiac arrest Laryngeal edema

Underlying cause: Acute C5 – C6 compressive myelopathy

Nursing Management:

  • The patient was closely monitored for vital signs (BP, pulse, SpO₂, respiration).
  • Neurological status was assessed regularly (level of consciousness, limb weakness).
  • Oxygen therapy was provided, and airway patency was maintained.
  • During cardiac arrest, CPR was performed as per ACLS protocol.
  • A laryngeal mask airway was secured during difficult intubation.
  • The patient was shifted to Neuro ICU for further management.
  • Mechanical ventilation was initiated and monitored.
  • Endotracheal intubation was performed and airway care was maintained.
  • Noradrenaline infusion was started and titrated to maintain blood pressure.
  • Continuous cardiac monitoring was done.
  • Sedation and neuromuscular paralysis were administered as prescribed.
  • Fluid balance was monitored, including input and output.
  • Bowel status was monitored, and constipation was managed.
  • Infection prevention measures were followed.
  • Patient positioning and pressure area care were maintained.
  • Family members were informed about the patient’s condition.

Discussion

The patient’s sudden neck pain followed by weakness in all four limbs suggested a serious spinal cord problem. Although the surgery and early post-operative period were stable, the patient suddenly developed respiratory distress with blood-stained sputum, low oxygen levels, and bradycardia, leading to cardiac arrest. This indicates that even stable patients can deteriorate rapidly and require close monitoring. Early recognition of complications, prompt CPR, airway management, and timely ICU care played an important role in managing the patient and improving the chances of survival.

Conclusion

This case showed that patients with acute neurological symptoms can deteriorate suddenly even after an uneventful surgery. Early recognition, continuous monitoring, and immediate emergency management such as CPR, airway support, and ICU care were important in avoiding life threatening catastrophes the patient’s life. Proper nursing care played a key role in patient stabilization and recovery.

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