Spinal Cord Injury and Complications Related to Neuraxial Anaesthesia Procedures: A Systematic Review

Abstract

The use of neuraxial procedures, such as spinal and epidural anaesthesia, has been linked to some possible complications. In addition, spinal cord injuries due to anaesthetic practice (Anaes-SCI) are rare events but remain a significant concern for many patients undergoing surgery. This systematic review aimed to identify high-risk patients summarise the causes, consequences, and management/recommendations of SCI due to neuraxial techniques in anaesthesia. A comprehensive search of the literature was conducted in accordance with Cochrane recommendations, and inclusion criteria were applied to identify relevant studies. From the 384 studies initially screened, 31 were critically appraised, and the data were extracted and analysed. The results of this review suggest that the main risk factors reported were extremes of age, obesity, and diabetes. Anaes-SCI was reported as a consequence of hematoma, trauma, abscess, ischemia, and infarction, among others. As a result, mainly motor deficits, sensory loss, and pain were reported. Many authors reported delayed treatments to resolve Anaes-SCI. Despite the potential complications, neuraxial techniques are still one of the best options for opioid-sparing pain prevention and management, reducing patients’ morbidity, improving outcomes, reducing the length of hospital stay, and pain chronification, with a consequent economic benefit. The main findings of this review highlight the importance of careful patient management and close monitoring during neuraxial anaesthesia procedures to minimise the risk of spinal cord injury and complications.

Complications in Spinal Anesthesia

“…Damage to the nerve vasculature during blocks can cause local or diffuse ischemia from direct injury or acute occlusion of the arteries or from hemorrhage within a nerve sheath [6].…”

Anestesia Obstétrica: Innovaciones Y Desafíos en La Cesáreas

“…Las complicaciones de la anestesia epidural incluyen la posibilidad de dolor de cabeza pospunción dural, complicaciones neurológicas secundarias al bloqueo neuroaxial y absceso epidural (10,11). Estas complicaciones son raras pero deben ser consideradas en la gestión de la anestesia epidural en la cesárea.…”

Comparison of Incidence of Post-Dural Puncture Headache in Patients Undergoing Spinal Anesthesia Following Median vs Paramedian Approach

“…Here are some reasons spinal anesthesia may be preferred over general anesthesia (Capdevila et al, 2020). Spinal anesthesia provides regional anesthesia, meaning it numbs a specific body region, usually below the level of the intended surgery (Pozza et al, 2023). This allows for effective pain control during and after the procedure (Plaat et al, 2022).…”