paraplegia after off-pump coronary artery by-pass grafting

Paraplegia is an exceedingly rare neurologic complication after off-pump coronary artery bypass graft (opcab) surgery commonly caused by spinal cord ischemia (sci). sci is not a well unknown clinical phenomenon in the postoperative course. sci has been reported after noncardiac surgery in otherwise healthy subjects in whom only one risks factor i.e. severe hypotension has been documented. sci has also been reported as a rare complication among the other neurologic sequels of cardiac surgery. we report a case of paraplegia in a patient with metabolic syndrome and multiples risk factors after an opcab. this patient may be considered as an interesting case as no any ischemic event was found in the imaging modalities and culprit lesion may be attributed to 1-left internal thoracic artery use as an important blood perfusion to anterior spinal artery vasculature and 2-disc herniation at intervertebral space of t as a culprit lesion 3-transient intraoperative hypotension. the patient was managed by lower extremities physiotherapy and skin care, however, after 3months of follow-up, no evidence of recovery was detected.