Intraoperative total spinal anesthesia as a complication of posterior percutaneous endoscopic cervical discectomy

Wu, Wenkai; Zhang, Yan

doi:10.1007/s00586-017-5424-9

Cited by 13 publications

(11 citation statements)

References 20 publications

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“…From the literature review, total spinal anesthesia can happen during epidural anesthesia, caudal anesthesia, spinal anesthesia, paravertebral block, stellate ganglion block, interscalene brachial blocks, and other regional anesthesia techniques performed at or near to the vertebral column. The clinical manifestations are often characterized by a sudden decrease in blood pressure, rapidly increasing motor block, temporary loss of breathing, loss of consciousness, dilated pupils, apnea, and even cardiac arrest [ [8] , [9] , [10] , [11] , [12] ].…”

Section: Discussionmentioning

confidence: 99%

A case of total spinal anesthesia

Asfaw

Eshetie

2020

International Journal of Surgery Case Reports

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Highlights Total spinal or a high neuraxial blockade is a recognized complication of central neuraxial techniques. Total spinal anesthesia is characterized by acute onset hemodynamic instability, shortness of breath, dyspnea, with a precipitous decline in GCS. It happened immediately after spinal anesthesia but it may happen even an hour after anesthesia. The anesthetist performing these procedures must be aware of this serious complication and must remain vigilant throughout. The management is mainly supportive care.

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Section: Discussionmentioning

confidence: 99%

A case of total spinal anesthesia

Asfaw

Eshetie

2020

International Journal of Surgery Case Reports

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“…The authors established that highly increased cervical epidural pressure by continuous saline irrigation was the main cause (39). Two cases of approach-related intraoperative total spinal anesthesia during posterior PECD were reported by Wu et al (40). Perforation on C6 lamina with the spinal needle during the approach lead anesthetics went through the iatrogenic hole to subarachnoid space.…”

Section: Complicationsmentioning

confidence: 99%

Percutaneous endoscopic cervical discectomy: a technical review

2018

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The treatment of cervical disc herniations has evolved in the last 2 decades. While the anterior cervical discectomy and fusion continues being the gold standard for the treatment of radicular pain triggered by cervical disc herniation, other surgical approaches have been developed. Percutaneous endoscopic cervical discectomy has demonstrated the ability to decompress the exiting nerve root and dural sac correctly and encouraging clinical outcomes has been reported in the literature. One of the most important advantages offered by the endoscopic technique is the capability to resolve the patient's symptoms without the need for interbody fusion. Also, a specific and selective decompression under continuous visualization with minimal surgery-related trauma can be achieved. There are two percutaneous endoscopic cervical discectomy approaches: anterior and posterior. The decision to perform each other depends on pathology site. However, the endoscopic technique requires previous surgical training, a steep learning curve, and proper patient selection. The development of new hardware such as endoscopes with better optics, lighting systems, and endoscopic surgical tools have allowed using endoscopic techniques in more complex cases. The objective of this review is the technical description of the anterior and posterior percutaneous endoscopic cervical discectomy.

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“…To date, numerous studies have reported p-PECD for the management of cervical disorders (19) (13,(15)(16)(17)(18)(19)(20)(21)(23)(24)(25)(26)(27) and have studied the inner diameter of the p-PECD working channel, ranging from 3.7 mm to 6.9 mm (17,22,28). However, no studies have been conducted to compare the clinical outcomes of the application of a 3.7 mm endoscope and 6.9 mm endoscope in CDH patients.…”

Section: Introductionmentioning

confidence: 99%

Comparative Evaluation of Posterior Percutaneous Endoscopy Cervical Discectomy Using 3.7 mm Endoscope and 6.9 mm Endoscope for Cervical Disc Herniation: a retrospective comparative cohort study

Zhang

et al. 2021

Preprint

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Background. Posterior percutaneous endoscopy cervical discectomy (p-PECD) is an effective strategy for the treatment of cervical diseases, with a working cannula ranging from 3.7 mm to 6.9 mm in diameter. However, to date, no studies have been performed to compare the clinical outcomes of the use of endoscopes with different diameters in cervical disc herniation (CDH) patients. The purpose of this study was to compare the clinical outcomes of patients with unilateral CDH treated with p-PECD using a 3.7 mm endoscope and a 6.9 mm endoscope.Methods. From January 2016 to June 2018, a total of 28 consecutive patients with single-level CDH who received p-PECD using either the 3.7 mm or the 6.9 mm endoscope were enrolled. The clinical results, including the surgical duration, hospitalization, visual analog scale (VAS) score and modified MacNab criteria, were evaluated. Cervical fluoroscopy, CT, and MRI were also performed during follow-up.Results. Tthere was a significant difference in regard to the average identification time of the “V” point (18.608±3.7607 min vs. 11.256±2.7161 min, p<0.001) and the mean removal time of the overlying tissue (16.650±4.1730 min vs. 12.712±3.3079 min, p<0.05) for the use of the 3.7 mm endoscope and the 6.9 mm endoscope, respectively. The postoperative VAS and MacNab scores of the two endoscopes were significantly improved compared with those the preoperative scores (p<0.05).Conclusion. The application of both the 3.7 mm endoscope and 6.9 mm endoscope represent an effective method for the treatment of CDH in selected patients, and no significant difference can be observed in the clinical outcomes of the endoscopes. The 6.9 mm endoscope shows superiority to the 3.7 mm endoscope in terms of the efficiency of “V” point identification, the removal of overlying soft tissue and the prevention of spinal cord injury. However, the 6.9 mm endoscope may be inferior to the 3.7 mm endoscope in regards to anterior foraminal decompression due to its large diameter; this result needs to be further evaluated with the support of a large number of randomized controlled trials.

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Intraoperative total spinal anesthesia as a complication of posterior percutaneous endoscopic cervical discectomy

Abstract: From these two cases, we concluded that the operation of anchoring during PECD should be cautious and standardized, intravenous anesthesia should be chosen to enhance intraoperative anesthesia to prevent intraoperative total spinal anesthesia.

Cited by 13 publications

References 20 publications

A case of total spinal anesthesia

A case of total spinal anesthesia

Percutaneous endoscopic cervical discectomy: a technical review

Comparative Evaluation of Posterior Percutaneous Endoscopy Cervical Discectomy Using 3.7 mm Endoscope and 6.9 mm Endoscope for Cervical Disc Herniation: a retrospective comparative cohort study

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