Catastrophic Complications Following Spinal Deformity Surgery in a Patient with Myotonic Dystrophy

Myotonic dystrophy (MD) is a genetic disorder that causes progressive muscle weakness and atrophy, often leading to spinal deformities and decreased quality of life. While the surgical correction of spinal deformities is not absolutely contraindicated in MD patients, a comprehensive pre-anesthetic evaluation is crucial, particularly considering cardiovascular and respiratory health. We present a case of a 50-year-old woman with MD who underwent spinal deformity surgery to correct kyphosis and alleviate severe back pain. Despite the absence of significant events during surgery and preoperative risk factors, the patient experienced postoperative respiratory failure, hypotension, aggravated weakness, and mental deterioration in the intensive care unit. The patient received long-term ventilator support during hospitalization for respiratory muscle weakness. She demonstrated significant improvements in strength, mobility, and respiratory function with multidisciplinary support and rehabilitation, achieving functional independence within 6 months postoperatively. The authors discuss the possible etiological mechanisms underlying these complications and highlight the need for preoperative evaluations and multidisciplinary care for patients with MD.