Spinal cord–like hypertension syndrome with metabolic acidosis and pulmonary edema following lumbar discectomy under general anesthesia: a case report

Percutaneous endoscopic lumbar discectomy (PELD) is a widely used minimally invasive spinal procedure. Rare but life-threatening complications related to irrigation-induced intraspinal hypertension have been reported, but cases under general anesthesia combined with metabolic acidosis and acute pulmonary edema are extremely rare and easily misdiagnosed. This case highlights a rare fatal complication and its clinical features to improve perioperative recognition and management.

A 56-year-old ASA II woman without hypertension or heart disease underwent elective PELD for L5–S1 disc herniation. Intraoperatively, persistent tachycardia and hypertension occurred despite adequate anesthesia depth. Postoperatively, she developed agitation, severe lactic acidosis, acute pulmonary edema, and required re-intubation and ICU treatment, complicated by stress cardiomyopathy. After systematic supportive therapy, she recovered and was discharged on postoperative day 12, with no sequelae at 1-month follow-up.

Spinal cord–like hypertension syndrome is a rare but catastrophic complication of PELD, especially under general anesthesia. Early warning signs include unexplained intraoperative tachycardia and hypertension. Perioperative strategies such as reducing irrigation volume/pressure, close surgeon–anesthesiologist communication, and early intervention can improve patient safety and prognosis.