Cord and Cauda Equina Injury Complicating Elective Orthopedic Surgery

Lewandrowski, Kai‐Uwe; McLain, Robert F.; Lieberman, Isadore; Orr, Douglas J.

doi:10.1097/01.brs.0000214968.58581.44

Cited by 24 publications

(9 citation statements)

References 14 publications

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“…Several cases raise concerns about performing neuraxial techniques in patients with spinal stenosis 30–34 . Motor weakness, sensory deficit and cauda equina syndrome have been reported following neuraxial anaesthesia in patients in whom a previously more or less symptomless spinal stenosis was diagnosed post‐operatively.…”

Section: Chronic Back Problems/spinal Stenosismentioning

confidence: 99%

Neuraxial techniques in patients with pre‐existing back impairment or prior spine interventions: a topical review with special reference to obstetrics

Vercauteren

Waets

Pitkänen

et al. 2011

Acta Anaesthesiol Scand

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Many anaesthetists consider neurological disorders of all kinds as a contraindication for regional anaesthesia particularly for neuraxial techniques. This hesitation is partly rooted in fears of medicolegal problems but also in the heterogeneous literature. Therefore, the present topical review is an attempt to describe the feasibility and the risks of neuraxial techniques in patients with spinal injury, anatomical compromise, chronic back pain or previous spinal interventions, ranging from 'minor' types like epidural blood patches to major surgery such as Harrington fusions. Most reviews and case reports were describing experiences in obstetrics as these patients are more likely to insist on neuraxial blocks. In the acute phase of new neurologic injury, general anaesthesia may be the technique of choice to prevent further haemodynamic and respiratory deterioration. After the acute phase, current evidence is mostly reassuring with respect to the risks of neuraxial blocks as they may even be recommendable in some conditions. Ultrasound technology may be of additional help to increase the success rate. A careful pre-operative examination remains mandatory, while patients should be sufficiently informed about technical aspects and possible relapses or progression of their disease. When necessary, patients should have additional technical and clinical examinations as close as possible to surgery to establish the actual pre-operative status. Most patients may benefit more from spinal techniques rather than from less reliable epidural ones. High concentrations and volumes of local anaesthetics should be avoided at all times, especially in patients with nerve compression, large disc herniation or spinal stenosis.

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Section: Chronic Back Problems/spinal Stenosismentioning

confidence: 99%

Neuraxial techniques in patients with pre‐existing back impairment or prior spine interventions: a topical review with special reference to obstetrics

Vercauteren

Waets

Pitkänen

et al. 2011

Acta Anaesthesiol Scand

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“…Although epidural infiltrations with corticosteroids are commonly performed to treat chronic back pain problems, several reports raise growing concerns about neuraxial techniques in patients with spinal stenosis or suspicion of compressive aetiology (43–48). Cauda equina, motor weakness and sensory deficit have been reported after neuraxial blocks in patients in whom the diagnosis of a relatively symptom‐less spinal stenosis was evidenced post‐operatively.…”

Section: Chronic Back Problems and Previous Spine Surgerymentioning

confidence: 99%

Anaesthetic considerations for patients with a pre‐existing neurological deficit: are neuraxial techniques safe?

Vercauteren

Heytens

2007

Acta Anaesthesiol Scand

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Pre-existing neurological and muscular disease may be a specific concern for anaesthetists as they need to consider the effect of anaesthesia upon the disease, vice versa, and the interaction of anaesthesia with the medication taken by the patient. Despite a lack of controlled studies, many anaesthetists, being afraid of a claim, will prefer general rather than regional anaesthesia in these patients. Nevertheless regional anaesthesia certainly merits its place because it offers undeniable advantages. A good pre-operative examination is very important while patients should also be informed about peri-operative implications of anaesthesia, surgery and stress. Paraesthesias, epinephrine and high concentrations of local anaesthetics should be avoided in the majority of the diseases. Some diseases may benefit from epidural anaesthesia while for others a spinal technique may be the technique of preference. Special attention should be paid to patients with spinal stenosis despite recent reassuring reports with respect to safety of regional anaesthetic techniques. Anaesthetists should not automatically take all responsibility in case of progressive or new deficit after the procedure.

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“…Furthermore, spinal stenosis can contribute to neurologic injury from surgery or positioning even in the absence of neuraxial anesthetic techniques. 45,46 Based on details gleaned from the limited literature on this topic and in accordance with the double-crush theory, 47 we believe it reasonable to speculate that patients with moderate to severe spinal stenosis might be more vulnerable to injury if there are coexisting conditions such as neuraxial surgery, preexisting neurologic disease, mucopolysaccharidosis, 48 nonneutral patient positioning, or conditions known or unknown that compete for limited crosssectional area within the spinal canal. Although the preponderance of spinal stenosis has been associated with epidural and combined spinal-epidural techniques, 12 association with spinal anesthesia has also been reported.…”

Section: Spinal Stenosismentioning

confidence: 99%

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

Neal

Kopp

Pasternak

et al. 2015

Regional Anesthesia and Pain Medicine

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Since publication of initial recommendations in 2008, new information has enhanced our understanding of 5 specific entities: spinal stenosis, blood pressure control during neuraxial anesthesia, neuraxial injury subsequent to transforaminal techniques, cauda equina syndrome/local anesthetic neurotoxicity/arachnoiditis, and performing regional anesthetic or pain procedures in patients concomitantly receiving general anesthesia or deep sedation.

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Cord and Cauda Equina Injury Complicating Elective Orthopedic Surgery

Cited by 24 publications

References 14 publications

Neuraxial techniques in patients with pre‐existing back impairment or prior spine interventions: a topical review with special reference to obstetrics

Neuraxial techniques in patients with pre‐existing back impairment or prior spine interventions: a topical review with special reference to obstetrics

Anaesthetic considerations for patients with a pre‐existing neurological deficit: are neuraxial techniques safe?

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

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