Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 55 12 2018 01 16 807 811 EN Aghigh Haidari Department of Cardiovasculary Surgery, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Feridoun Sabzi Department of Cardiovasculary Surgery, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Samsam Dabiri Department of Cardiovasculary Surgery, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2015 10 24 2016 09 27 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. https://acta.tums.ac.ir/index.php/acta/article/view/5044 https://acta.tums.ac.ir/index.php/acta/article/download/5044/5035