Is inpatient status medically necessary for a patient with neck pain radiating down their back and bilateral lower extremity (B/L LE) paresthesias, with Magnetic Resonance Imaging (MRI) findings of multiple disc herniations at C5-C6 and C6-C7, undergoing cervical arthroplasty?

Inpatient Status for Cervical Disc Arthroplasty with Spinal Cord Compression

Yes, 2 inpatient bed days are medically necessary for this patient with severe cervical spinal cord compression at C5-C6 and C6-C7 requiring cervical arthroplasty, given the presence of bilateral lower extremity paresthesias indicating spinal cord impingement and the need for immediate postoperative neurological monitoring.

Clinical Justification for Admission

Preoperative Indication for Inpatient Status

The patient meets clear criteria for inpatient admission based on neurological findings:

• Spinal cord impingement is evidenced by bilateral lower extremity paresthesias and "electric shock" sensations radiating down the spine into the legs, which represents a neurologic abnormality suggesting spinal cord compression 1
• Severe spinal canal narrowing at two contiguous levels (C5-C6 and C6-C7) on MRI constitutes acute neurological risk requiring urgent surgical intervention 1
• The presence of bilateral symptoms with progressive nature (worsening over the past week) indicates evolving cord compression that necessitates immediate surgical decompression 1

Surgical Timing and Urgency

Emergency surgical decompression within 24 hours is recommended for patients with traumatic or progressive spinal cord compression to improve long-term neurological recovery 1. While this patient's presentation is degenerative rather than traumatic, the bilateral lower extremity involvement with progressive symptoms over days indicates similar urgency for decompression to prevent permanent neurological deficit 1.

Postoperative Monitoring Requirements

Day 1 (Surgery Day)

The immediate postoperative period requires inpatient monitoring for:

• Neurological deterioration risk: Patients undergoing cervical decompression can experience postoperative neurological worsening, including increased paresthesias, weakness, or new deficits 1
• Vital signs and neuro checks q4h as documented in the care plan are essential to detect early complications 1
• JP drain management and monitoring for hematoma formation, which occurs in approximately 0.01% of cases but can cause acute cord compression requiring emergent intervention 2
• Airway monitoring: Dysphagia occurs in up to 70% of patients post-cervical arthroplasty, and laryngeal nerve injury occurs in 0-1.25% of cases, both requiring close observation 2

Day 2 (First Postoperative Day)

The second inpatient day is justified by:

• Continued neurological assessment: The critical window for detecting postoperative complications including cord edema, epidural hematoma, or device-related issues extends through the first 24-48 hours 1, 2
• Mobilization assessment: Safe ambulation and neurological stability must be confirmed before discharge, particularly given the preoperative bilateral lower extremity symptoms 3
• Pain control optimization: Adequate pain management and transition to oral medications requires inpatient monitoring 3

Specific Complications Requiring Inpatient Surveillance

Short-term complications that manifest within the first 48 hours include:

• Gross device extrusion (~0.3% incidence) 2
• Hematoma formation requiring potential evacuation 2
• Horner syndrome (~0.06% incidence) 2
• C5 radiculopathy which can occur postoperatively and requires immediate recognition 4

Common Pitfalls to Avoid

Do not discharge based solely on surgical completion without adequate neurological monitoring. The patient's preoperative bilateral lower extremity paresthesias indicate significant cord compression, and postoperative neurological status can worsen before improving, as demonstrated in case reports where patients experienced increased symptoms immediately after decompression 1.

Do not assume uncomplicated surgery eliminates monitoring needs. Even procedures completed "without complications" require standard postoperative observation periods for cervical spine surgery with cord involvement 1, 2.

MCG Criteria Alignment

The patient meets MCG admission criteria for:

• Back Pain ORG: M-63 - "Other neurologic abnormality suggesting spinal cord impingement" is clearly present with bilateral lower extremity paresthesias and electric shock sensations [@patient criteria provided]
• Disk Arthroplasty, Cervical ACG: A-0227 - The procedure is indicated and was performed, requiring standard postoperative inpatient care [@patient criteria provided]

The 2-day inpatient stay ([DATE]-[DATE]) represents the minimum necessary period for safe postoperative monitoring following cervical arthroplasty in a patient with preoperative spinal cord compression and bilateral neurological symptoms 1, 2.