Anatomy and Pathophysiology of Spinal Cord Injury Associated With Regional Anesthesia and Pain Medicine

Neal, Joseph M.; Kopp, Sandra L.; Pasternak, Jeffrey J.; Lanier, William L.; Rathmell, James P.

doi:10.1097/aap.0000000000000297

Cited by 36 publications

(12 citation statements)

References 159 publications

(170 reference statements)

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“…A review of literature of Neal et al focused on the pathophysiology of spinal cord injuries after regional anesthesia, including the use of epidural catheters. Even in the setting of spinal stenosis, neuraxial injuries were found exceedingly rare [ 20 ]. Evidence was found for a possible association between spinal stenosis and a higher complication rate after neuraxial blockade.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of continuous epidural analgesia in patients with failed back surgery syndrome and spinal stenosis

et al. 2022

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Purpose The purpose of this study was to outline the feasibility of continuous epidural analgesia in the treatment of failed back surgery syndrome (FBSS) or spinal stenosis. Methods We queried our prospective collected institutional database to include all consecutive patients, who underwent continuous epidural analgesia with accompanying intensive physiotherapeutic exercise within a timeframe of 4 years. Patients suffered from FBSS or spinal stenosis; protocolled continuous epidural analgesia was planned for 4 days within the framework of an inpatient multimodal pain therapy concept. The instillation technique of the epidural catheter, the capability to attend in accompanying physiotherapy, and the peri-interventional complications were evaluated. Results 153 patients with an average age of 57.4 years (± 11.9) were enrolled in this study. 105 patients suffered from FBSS and 48 patients had spinal stenosis. Overall, 148 patients (96.7%) reported the pain reduction and were able to perform daily intensified physiotherapeutic exercise. There were no serious adverse events, neither infection nor bleeding, no cardiopulmonary complication or permanent neurological deficits. The most common side effect was neurological impairment, such as numbness, dysesthesia, or weakness of the lower limbs with complete regression after flow rate adjustment. Patients with FBSS were more likely to develop dysesthesia (p = 0.007). Conclusions Continuous epidural analgesia is feasible in patients with FBSS or spinal stenosis. This treatment enables extensive physiotherapeutic treatment even in patients with severe pain conditions and can be considered as an alternative to epidural injections. An increased complication rate in comparison to short-term perioperative or perinatal application was not observed.

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Section: Discussionmentioning

confidence: 99%

“…But in most cases, the spinal stenosis was not diagnosed before the intervention and was detected only as part of the complications. To summarize, there is no clear evidence that spinal stenosis or postoperative changes of the lumbar spine per se cause these higher complication rates [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of continuous epidural analgesia in patients with failed back surgery syndrome and spinal stenosis

et al. 2022

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“…Spinal anesthesia, a type of regional anesthesia that involves injecting a local anesthetic (LA) into the subarachnoid space, is widely used in surgeries of the lower abdomen, pelvis, and lower extremities 1. LAs provide a good analgesic effect but they have some degree of neurotoxicity and are known to cause neurological complications such as transient neurological symptom, cauda equina syndrome, Guillain–Barre syndrome, and delayed sacral neurosensory disorder 2,3. The patient may be vulnerable to neurotoxicity even with clinically recommended doses of LA and inclusion of adjuvants 4.…”

Section: Introductionmentioning

confidence: 99%

<p>Monosialoganglioside protects against bupivacaine-induced neurotoxicity caused by endoplasmic reticulum stress in rats</p>

Liu¹,

Ji²,

Feng³

et al. 2019

DDDT

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Background Local anesthetics in spinal anesthesia have neurotoxic effects, resulting in severe neurological complications. Intrathecal monosialoganglioside (GM1) administration has a therapeutic effect on bupivacaine-induced neurotoxicity. The aim of this study was to determine the underlying mechanisms of bupivacaine-induced neurotoxicity and the potential neuroprotective role of GM1. Materials and methods A rat spinal cord neurotoxicity model was established by injecting bupivacaine (5%, 0.12 μL/g) intrathecally. The protective effect of GM1 (30 mg/kg) was evaluated by pretreating the animals with it prior to the bupivacaine regimen. The neurological and locomotor functions were assessed using standard tests. The histomorphological changes, neuron degeneration and apoptosis, and endoplasmic reticulum stress (ERS) relevant markers were analyzed using immunofluorescence, quantitative real-time PCR, and Western blotting. Results Bupivacaine resulted in significant neurotoxicity in the form of aberrant neurolocomoter functions and spinal cord histomorphology and neuronal apoptosis. Furthermore, the ERS specific markers were significantly upregulated during bupivacaine-induced neurotoxicity. These neurotoxic effects were ameliorated by GM1. Conclusion Pretreatment with GM1 protects against bupivacaine-induced neurotoxicity via the inhibition of the GRP78/PERK/eIF2α/ATF4-mediated ERS.

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“…The pathophysiology of spinal cord injury associated with regional anaesthetic techniques has been reviewed in depth, including that related to mechanical trauma from direct needle/catheter injury or mass lesions, spinal cord ischemia or vascular injury from direct needle/catheter trauma, and neurotoxicity from local anaesthetics, adjuvants, or antiseptics. Specific recommendations are offered that may reduce the likelihood of spinal cord injury associated with regional anaesthetic or interventional pain medicine techniques [4].…”

Section: Introductionmentioning

confidence: 99%

Thoracic Unilateral Spinal Cord Syndrome Following Neuraxial Anaesthesia for Periprosthetic Knee Fracture: A Case Report

Torija¹,

Ramiro-Ruiz²,

Salas³

et al. 2019

OJAnes

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Neuraxial anaesthesia is widely used in surgical procedures; overall, epidural and intrathecal techniques. Nevertheless, several outcomes should be considered. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear (0%-0.08%), although there are several described cases of spinal cord ischemia. We present a case of thoracic unilateral spinal cord syndrome following lumbar spinal anaesthesia for periprosthetic knee fracture. Our patient suffered monoparesis in her left lower limb as well as decreasing of muscle strength and loss of tendon reflexes. The MNR showed left hyperintense intra-cord images from T7 to T12 attributed to spinal cord oedema and a lineal hypointensity related to minimal haematic component. What made this case surprising was the fact that spinal anaesthesia was performed between L3 and L4 and the patient did not suffer paraesthesia associated with local anaesthetic injection. She was treated with glucocorticoids, gabapentin and amitriptyline. She also was checked by physical rehabilitators, neurologists and Pain Unit physicians. We have found another case reported in the literature about thoracic cord injury after lumbar spinal puncture. In this paper, we report possible aetiologies according to a review and neurological evolution of the patient seven months later.

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Anatomy and Pathophysiology of Spinal Cord Injury Associated With Regional Anesthesia and Pain Medicine

Cited by 36 publications

References 159 publications

Feasibility of continuous epidural analgesia in patients with failed back surgery syndrome and spinal stenosis

Feasibility of continuous epidural analgesia in patients with failed back surgery syndrome and spinal stenosis

<p>Monosialoganglioside protects against bupivacaine-induced neurotoxicity caused by endoplasmic reticulum stress in rats</p>

Thoracic Unilateral Spinal Cord Syndrome Following Neuraxial Anaesthesia for Periprosthetic Knee Fracture: A Case Report

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