Paraplegia following oesophagectomy

Shahi, Navneel; Asante-Siaw, Julius; Marzouk, J.F.K.

doi:10.1136/bcr.09.2009.2270

Cited by 2 publications

(5 citation statements)

References 7 publications

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“…To our knowledge, our study is the first report of spinal cord injury associated with extremity surgery in patients with skeletal dysplasia. Neurologic sequelae related to the spinal cord are rare after nonspinal operations, with the overall incidence estimated to be 0.08% [2,19].…”

Section: Discussionmentioning

confidence: 99%

“…All but one of the patients in these studies sustained a spinal cord injury while they were in the prone position, whereas our patients were in the supine position [1,3,[19][20][21]. Paraplegia attributable to a thoracic spinal cord infarction was described in a 16-year-old patient with Morquio syndrome (mucopolysaccharidosis IV) [25].…”

Section: Spinal Cord Ischemiamentioning

confidence: 99%

“…There are more segmental arteries supplying the posterior spinal arteries than the anterior arteries, which accounts for anterior spinal artery syndrome being more frequently observed [19]. The diameter of spinal vessels may influence the blood flow through the spinal cord [15,19]. In a dynamic flexion cadaveric study, Farley et al [9] found that, in thoracic kyphosis exceeding 63°, spinal cord intramedullary pressure increased significantly compared with less substantial curves in the same specimen.…”

Section: Spinal Cord Ischemiamentioning

confidence: 99%

“…The posterior spinal arteries are fed by segmental arteries that arise from the aorta. There are more segmental arteries supplying the posterior spinal arteries than the anterior arteries, which accounts for anterior spinal artery syndrome being more frequently observed [19]. The diameter of spinal vessels may influence the blood flow through the spinal cord [15,19].…”

Section: Spinal Cord Ischemiamentioning

confidence: 99%

“…Low MAP (\ 60 mm Hg) is an important risk factor for spinal cord injury intra-and postoperatively [6]. Data regarding spinal ischemia injury in patients in the supine position are limited [19]. Blood pressure changes and heart rate instability may not be sensitive enough to caution the surgical team regarding low cardiac output [25].…”

Section: Blood Pressure and Mapmentioning

confidence: 99%

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Spinal Cord Injury After Extremity Surgery in Children With Thoracic Kyphosis

Pruszczyński

Mackenzie

Rogers

et al. 2015

Clin Orthop Relat Res

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Background Spinal cord injury is a rare complication after lower extremity surgery in children with skeletal dysplasia and thoracic kyphosis. We encountered two patients who had this complication, from among 51 (39 from Nemours/Alfred I. duPont Hospital for Children and 12 from Seattle Children's Hospital) who underwent lower extremity surgery during an 8.5-year period (June 2004 to December 2012). Because spinal cord injury is a devastating complication likely not known to most physicians treating patients with skeletal dysplasias, we sought to examine factors that may contribute to this rare complication. Case Description We performed a retrospective review of two patients with skeletal dysplasia who had paraplegia develop after extremity surgery. Outcome measures included operative time, vital signs, and postsurgery recovery of neurologic deficit. MR images were reviewed. Two patients were found-an 8.5-year-old boy with spondyloepiphyseal dysplasia congenita with a 76°-thoracic kyphosis apex at T4 and a 6.5-year-old boy with mucopolysaccharidosis type 1-H with an 80°-thoracic kyphosis apex at T2. Bilateral proximal femoral osteotomies or bilateral innominate and proximal femoral osteotomies had been performed. The spinal cord injuries occurred at the apex of the kyphosis as determined by clinical examination and MRI assessment. In both patients, the mean arterial blood pressure decreased below 50 mm Hg and might be a factor in the etiology of the paralysis. The first patient recovered motor function in 5 months; the second had no recovery. Literature Review Paraplegia is extremely rare after nonspine operations. Many factors contribute to the risk for a spinal cord event: low mean arterial pressure, duration of the surgery, position on the operating table, the kyphotic spine deformity, or unappreciated vascular disease. Motorevoked potentials and somatosensory-evoked potentials together potentially provide high sensitivity and specificity for predicting a postoperative neurologic deficit. Clinical Relevance Based on our two patients with skeletal dysplasia and a literature review of patients with hyperkyphosis undergoing extremity surgery, the surgeon must be aware of the risk of spinal cord injury. Careful preoperative assessment possibly including MRI of the spine is recommended. Mean arterial pressure should be maintained at a safe level; neuromonitoring should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Spinal Cord Ischemiamentioning

confidence: 99%

Section: Spinal Cord Ischemiamentioning

confidence: 99%

Section: Spinal Cord Ischemiamentioning

confidence: 99%

Section: Blood Pressure and Mapmentioning

confidence: 99%

See 3 more Smart Citations

Spinal Cord Injury After Extremity Surgery in Children With Thoracic Kyphosis

Pruszczyński

Mackenzie

Rogers

et al. 2015

Clin Orthop Relat Res

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Intraoperative Neurological Monitoring in Lower Limb Surgery for Patients With Mucopolysaccharidoses

Georgiadis

Koester

Mackenzie

et al. 2020

Journal of Pediatric Orthopaedics

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Background: There are reports of spinal cord injury (SCI) occurring after lower extremity (LE) surgery in children with mucopolysaccharidoses (MPS). Intraoperative neurological monitoring (IONM) has been adopted in some centers to assess real-time spinal cord function during these procedures. The aim of this investigation was to review 3 specialty centers’ experiences with MPS patients undergoing LE surgery. We report how IONM affected care and the details of spinal cord injuries in these patients. Methods: All pediatric MPS patients who underwent LE surgery between 2001 and 2018 were reviewed at 3 children’s orthopaedic specialty centers. Demographic and surgical details were reviewed. Estimated blood loss (EBL), surgical time, positioning, use of IONM, and changes in management as a result of IONM were recorded. Details of any spinal cord injuries were examined in detail. Results: During the study period, 92 patients with MPS underwent 252 LE surgeries. IONM was used in 83 of 252 (32.9%) surgeries, and intraoperative care was altered in 17 of 83 (20.5%) cases, including serial repositioning (n=7), aggressive blood pressure management (n=6), and abortion of procedures (n=8). IONM was utilized in cases with larger EBL (279 vs. 130 mL) and longer operative time (274 vs. 175 min) compared with procedures without IONM. Three patients without IONM sustained complete thoracic SCI postoperatively, all from cord infarction in the upper thoracic region. These 3 cases were characterized by long surgical time (328±41 min) and substantial EBL (533±416 mL or 30.5% of total blood volume; range, 11% to 50%). No LE surgeries accompanied by IONM experienced SCI. Conclusions: Patients with MPS undergoing LE orthopaedic surgery may be at risk for SCI, particularly if the procedures are long or are expected to have large EBL. One hypothesis for the etiology of SCI in this setting is hypoperfusion of the upper thoracic spinal cord due to prolonged intraoperative or postoperative hypotension. IONM during these procedures may mitigate the risk of SCI by identifying real-time changes in spinal cord function during surgery, inciting a change in the surgical plan. Level of Evidence: Level III—retrospective comparative series.

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Paraplegia following oesophagectomy

Cited by 2 publications

References 7 publications

Spinal Cord Injury After Extremity Surgery in Children With Thoracic Kyphosis

Spinal Cord Injury After Extremity Surgery in Children With Thoracic Kyphosis

Intraoperative Neurological Monitoring in Lower Limb Surgery for Patients With Mucopolysaccharidoses

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