Prevention, identification, and treatment of perioperative spinal cord injury

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>In this report, the authors suggest evidence-based approaches to minimize the chance of perioperative spinal cord injury (POSCI) and optimize outcome in the event of a POSCI.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A systematic review of the basic science and clinical literature is presented.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Authors of clinical studies have assessed intraoperative monitoring to minimize the chance of POSCI. Furthermore, preoperative factors and intraoperative issues that place patients at increased risk of POSCI have been identified, including developmental stenosis, ankylosing spondylitis, preexisting myelopathy, and severe deformity with spinal cord compromise. However, no studies have assessed methods to optimize outcomes specifically after POSCIs. There are a number of studies focussed on the pathophysiology of SCI and the minimization of secondary damage. These basic science and clinical studies are reviewed, and treatment options outlined in this article.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>There are a number of treatment options, including maintenance of mean arterial blood pressure &gt; 80 mm Hg, starting methylprednisolone treatment preoperatively, and multimodality monitoring to help prevent POSCI occurrence, minimize secondary damage, and potentially improve the clinical outcome of after a POSCI. Further prospective cohort studies are needed to delineate incidence rate, current practice patterns for preventing injury and minimizing the clinical consequences of POSCI, factors that may increase the risk of POSCI, and determinants of clinical outcome in the event of a POSCI.</jats:p></jats:sec>

Compressive myelopathy in severe angular kyphosis: a series of ten patients

“…All operations were performed by the senior author under monitoring of somatosensory-evoked potential (SSEP) and motor-evoked potentials (MEP). All four adult patients were given methylprednisolone with 30 mg/kg 30 min before the decompressive procedure [11]. The VCR procedure involved laminectomy, facetectomies, and provisional instrumentation followed by the corpectomy and discectomy.…”

The Use of Modest Systemic Hypothermia After Iatrogenic Spinal Cord Injury During Surgery

“…Iatrogenic SCI, although uncommon, is a known, devastating complication of spine surgery with an incidence of 0%-3% (Ahn and Fehlings, 2008). Common factors influencing outcomes are the surgical approach, type of pathology, and level of the spine surgery (Fielding, 1992;Faciszewski et al, 1995).…”

“…The incidence ranges 0%-3% and depends upon the surgical approach, type of pathology, and the level of the spine involvement (Ahn and Fehlings, 2008). Current management includes steroid administration via a methylprednisolone protocol infusion (Busto et al, 1987;Bracken et al, 1990Bracken et al, , 1992Bracken et al, , 1997Bracken et al, , 1998 and/or optimal spinal cord perfusion maintenance (Vale et al, 1997) with elevation of mean arterial pressures.…”

Editorial: Neuromonitoring

“…Several published reports from other authors have reported the use of intraoperative spinal cord monitoring as a meth od to identify neural irritation or injury at a time when the surgeon can take steps to reduce or reverse it. [1][2][3][4] The low complication rate in this series may be a re flection of the expertise of the authors in treating cervical spine disease or may result from the possibility that all complications were not captured in this retrospective re view. It is important to point out that in hospitals in which surgical volume is not comparable to the University of Iowa Hospitals & Clinics, the risk of neurological deficit when not using intraoperative spinal cord monitoring may be greater.…”