Intra-aortic Balloon Counterpulsation-Assisted Cardiac Support in the Anesthetic Management of Surgery for Acute Cervical Spine Compression With Severe Coronary Artery Disease in the Prone Position

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Acute cervical spine compression with severe coronary artery disease (ACS with NSTEMI) (n=1). Intervention: Intra-aortic balloon pump (IABP). Primary outcome: Perioperative hemodynamic stability and successful surgical decompression without ischemic or neurological complications.

Q: What does this research mean for the field?

Perioperative intra-aortic balloon counterpulsation provides effective hemodynamic stabilization and prevents myocardial ischemia during urgent cervical spine decompression in patients with severe coronary artery disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Priya Motiani; Swathi Mallikarjuna; Murali Chakravarthy; Shafiya Shaikh

doi:10.7759/cureus.117179

September 29, 2026CureusOpen Access

Intra-aortic Balloon Counterpulsation-Assisted Cardiac Support in the Anesthetic Management of Surgery for Acute Cervical Spine Compression With Severe Coronary Artery Disease in the Prone Position

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Key result

Perioperative IABP enables successful urgent cervical spine decompression in severe CAD.

n=1

Why the study?

Management of severe coronary artery disease during urgent cervical spine surgery in the prone position is challenging and perioperative hemodynamic control is critical.

Key Points

To describe the anesthetic and hemodynamic management of urgent cervical spine decompression in the prone position using intra-aortic balloon counterpulsation in a patient with severe coronary artery disease.
A 74-year-old male with acute cervical cord compression, triple-vessel coronary artery disease, and severe left ventricular dysfunction was scheduled for urgent C3-C7 laminectomy and lateral mass fixation.
Intra-aortic balloon counterpulsation (IABC) was placed after the induction of general anesthesia to provide intraoperative mechanical circulatory support during prone positioning.
Synchronized intra-aortic balloon counterpulsation maintained intraoperative hemodynamic stability, preserving cervical spinal cord perfusion throughout prone positioning.
The intervention prevented perioperative myocardial ischemia and infarction, enabling an uncomplicated postoperative recovery without neurological deterioration.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 74-year-old male with acute cervical spinal cord compression and concomitant acute coronary syndrome who underwent urgent surgery in the prone position with perioperative IABP support.

I

Intervention

Intra-aortic balloon pump (IABP) counterpulsation inserted post-induction of general anesthesia via the right femoral artery (1:1 ECG trigger, 100% augmentation), maintained intraoperatively alongside noradrenaline infusion, and weaned postoperatively.

O

Outcome

Intraoperative hemodynamic stability and prevention of perioperative myocardial ischemia/infarction and cervical cord hypoperfusion.safety

Prophylactic IABP insertion can safely facilitate intraoperative hemodynamic stability in carefully selected patients with severe coronary artery disease and LV dysfunction undergoing urgent, high-risk noncardiac surgery in the prone position.

Limitations

Single case report limits generalizability
Does not provide evidence for routine use of IABP in noncardiac surgery for patients with ACS or LV dysfunction
Lack of large trials or studies on the perioperative use of IABP in this setting
Trials and studies on the perioperative use of IABP are lacking
Findings are from a single case and should not be interpreted as evidence for routine IABP use in noncardiac surgery for patients with ACS or LV dysfunction

Implication

May support IABP in select high-risk prone noncardiac cases; hypothesis-generating and should not yet change practice.

Abstract

Severe coronary artery disease associated with the requirement for urgent cervical spine surgery in an elderly patient in a prone position is challenging for the anesthesiologist.Perioperative hemodynamic parameters are key to surgical success.Intra-aortic balloon counterpulsation (IABC) is a well-established modality for the management of patients with ischemic heart disease.There are very few case reports on management in noncardiac surgery with IABC.Here, we present a case report of a 74-year-old male patient with cervical cord compression scheduled for C3-C7 laminectomy and lateral mass fixation, with severe coronary artery disease and a recent history of severe coronary artery disease with triple-vessel disease and severely impaired left ventricular function, managed with IABC insertion post-induction of general anesthesia for intraoperative hemodynamic management to prevent cervical cord hypoperfusion and perioperative myocardial ischemia/infarction.

Discussion

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Cite This Study

Motiani et al. (2026) conducted a case report in Acute cervical spine compression with severe coronary artery disease (ACS with NSTEMI) (n=1). Intra-aortic balloon pump (IABP) was evaluated on Perioperative hemodynamic stability and successful surgical decompression without ischemic or neurological complications. Perioperative use of an intra-aortic balloon pump provided effective hemodynamic stabilization and enabled successful urgent cervical spine decompression in a patient with severe coronary artery disease.

synapsesocial.com/papers/6ace6db8b52af824ab02bb37 https://doi.org/10.7759/cureus.117179

Topics

Coronary artery disease

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Intra-aortic Balloon Counterpulsation-Assisted Cardiac Support in the Anesthetic Management of Surgery for Acute Cervical Spine Compression With Severe Coronary Artery Disease in the Prone Position

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Intra-aortic Balloon Counterpulsation-Assisted Cardiac Support in the Anesthetic Management of Surgery for Acute Cervical Spine Compression With Severe Coronary Artery Disease in the Prone Position

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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