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Cervical Spinal Cord Infarction Following Cervical Spine Decompressive Surgery.
MedLine Citation:
PMID:  23268196     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: Spinal cord infarction is a rare cause of neurologic deterioration after cervical spine decompressive surgery. Proposed causes of ischemic events include intraoperative or postoperative hypotension, or decreased venous return in conjunction with elevated vertebral venous pressures, which reduces arterial perfusion when patients undergo surgery in the prone position. Neuro-imaging is pivotal to exclude reversible causes for neurologic changes and confirmation of spinal cord infarction. We report five patients who underwent cervical decompressive surgeries and developed persistent postoperative neurological deficits compatible with spinal cord infarctions and evaluate causes for these rare complications. METHODS: The clinical courses and imaging studies of five patients were retrospectively analyzed. Imaging findings, types of surgeries, vascular compromise or risk factors, hypotensive episodes, intraoperative somatosensory evoked potentials, concomitant brain infarctions, and clinical degree and radiographic extent of spinal cord infarction were studied. Spinal cord infarctions were determined by clinical courses and imaging evaluations. RESULTS: All five patients had antecedent cervical cord region vascular compromise or generalized vascular risk factors. Four patients developed hypotensive episodes: two intraoperatively and two postoperatively. None of the four patients with hypotensive episodes had imaging or clinical evidence of concomitant brain infarctions. CONCLUSIONS: The neuroimaging evaluation of spinal cord infarction after decompressive surgery is to exclude spinal cord compression, to ensure adequate surgical decompression, and to confirm infarction by imaging. The authors propose that antecedent, unrecognized preoperative vascular compromise may be a significant contributor to spinal cord infarction by itself, or in combination with hypotension.
Authors:
Samuel Kalb; Saeed Fakhran; Bruce Dean; Jeffrey Ross; Randall W Porter; Udaya K Kakarla; Paul Ruggieri; Nicholas Theodore
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-22
Journal Detail:
Title:  World neurosurgery     Volume:  -     ISSN:  1878-8750     ISO Abbreviation:  World Neurosurg     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101528275     Medline TA:  World Neurosurg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
Division of Neurological Surgery, Barrow Neurological Institute St. Joseph's Hospital and Medical Center Phoenix, Arizona.
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