Cauda equina syndrome after induction of spinal anesthesia

Özgen, Serdar; Baykan, Nigar; Doğan, İhsan; Konya, Deniz; Pamir, Mustafa

doi:10.3171/foc.2004.16.6.5

Cited by 18 publications

(13 citation statements)

References 19 publications

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“…Limited to case reports reporting on either epidural or single episodes of spinal anaesthesia without any form of anticoagulation, we identified 21 such reports (12 epidurals, nine spinal anaesthesia) at platelet counts <100 × 10 9 /l at the time of puncture or catheter removal (Bailey et al , 1999; Moen et al , 2004; Nguyen et al , 2006; Morisaki et al , 1995; Gustafsson et al , 1988; Chang et al , 2003; Ezri et al , 2002; Harnett et al , 2000; Hew‐Wing et al , 1989; Kuczkowski & Benumof, 2002; Landau et al , 2003; Moeller‐Bertram et al , 2004; Nafiu et al , 2004; Ozgen et al , 2004; Raft et al , 2005; Sibai et al , 1986; Steer, 1993; Tamakawa & Ogawa, 1998; Wulf et al , 1988; Yuen et al , 1999). Sixteen were for analgesia during delivery (Bailey et al , 1999; Nguyen et al , 2006; Moen et al , 2004; Chang et al , 2003; Ezri et al , 2002; Harnett et al , 2000; Hew‐Wing et al , 1989; Kuczkowski & Benumof, 2002; Landau et al , 2003; Moeller‐Bertram et al , 2004; Nafiu et al , 2004; Raft et al , 2005; Steer, 1993; Yuen et al , 1999; Sibai et al , 1986).…”

Section: Case Reports In Regional Anaesthesiamentioning

confidence: 99%

The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals

2009

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Summary Neuraxial anaesthesia is increasingly performed in thrombocytopenic patients at the time of delivery of pregnancy. There is a lack of data regarding the optimum platelet count at which spinal procedures can be safely performed. Reports are often confounded by the presence of other risk factors for spinal haematomata, such as anticoagulants, antiplatelet agents and other acquired or congenital coagulopathies/platelet function defects or rapidly falling platelet counts. In the absence of these additional risk factors, a platelet count of 80 × 109/l is a ‘safe’ count for placing an epidural or spinal anaesthetic and 40 × 109/l is a ‘safe’ count for lumbar puncture. It is likely that lower platelet counts may also be safe but there is insufficient published evidence to make recommendations for lower levels at this stage. For patients with platelet counts of 50–80 × 109/l requiring epidural or spinal anaesthesia and patients with a platelet count 20–40 × 109/l requiring a lumbar puncture, an individual decision based on assessment of risks and benefits should be made.

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Section: Case Reports In Regional Anaesthesiamentioning

confidence: 99%

The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals

2009

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“…Although rare, case reports have shown an association with spinal anaesthesia. [1–3] Damage to nerve roots of cauda equina following spinal anaesthesia may occur due to compression, inflammation, stretching due to abnormal position, direct trauma, and spinal ischaemia or as a result of neurotoxicity of local anaesthetics. [2–4]…”

mentioning

confidence: 99%

Cauda equina syndrome following an uneventful spinal anaesthesia

Jain¹,

Srivastava²,

Saxena³

et al. 2010

Indian J Anaesth

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“…Less common causes are epidural haematoma [22], infections [6], primary and metastatic neoplasms [3], trauma [17,20,45], post surgical [21], prolapse after manipulation [40], after chemonucleolysis [41], after spinal anaesthesia [34] and it has been reported in patients with ankylosing spondylitis [38], gunshot wounds [13] and even resulting from constipation [27]. This review will address the problem of CES resulting from compression by lumbar disc herniation, prolapse or sequestration about which most has been written.…”

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confidence: 99%

Cauda equina syndrome: a review of the current clinical and medico-legal position

Gardner¹,

2010

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Cauda equina syndrome (CES) is a rare condition with a disproportionately high medico-legal profile. It occurs most frequently following a large central lumbar disc herniation, prolapse or sequestration. Review of the literature indicates that around 50-70% of patients have urinary retention (CES-R) on presentation with 30-50% having an incomplete syndrome (CES-I). The latter group, especially if the history is less than a few days, usually requires emergency MRI to confirm the diagnosis followed by prompt decompression by a suitably experienced surgeon. Every effort should be made to avoid CES-I with its more favourable prognosis becoming CES-R while under medical supervision either before or after admission to hospital. The degree of urgency of early surgery in CES-R is still not in clear focus but it cannot be doubted that earliest decompression removes the mechanical and perhaps chemical factors which are the causes of progressive neurological damage. A full explanation and consent procedure prior to surgery is essential in order to reduce the likelihood of misunderstanding and litigation in the event of a persistent neurological deficit.

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Cauda equina syndrome after induction of spinal anesthesia

Cited by 18 publications

References 19 publications

The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals

The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals

Cauda equina syndrome following an uneventful spinal anaesthesia

Cauda equina syndrome: a review of the current clinical and medico-legal position

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