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

BACKGROUND: 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. CASE PRESENTATION: 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. CONCLUSIONS: 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.