The risk of paraplegia through medical treatment

Abstract

In the Orthopedic University Hospital of Heidelberg (section Orthopedics II, treatment and rehabilitation of paraplegics), 21 patients with iatrogenic paraplegia were treated between 1968 and 1991. Paraplegia occurred in nine cases after procedures close to the spinal cord. In 12 cases paraplegia complicated medical treatment. Procedures close to the spinal cord, such as laminectomy, vertebrotomy, spondylodesis, and peridural anaesthesia, involve the risk of mechanical damage to the spinal cord, the level of paraplegia depends on the area of treatment. Any previous damage to the spinal cord increases the risk of paraplegic complications. The main risks in procedures distant from the spinal cord, such as vascular surgery, angiography, radiotherapy, bronchial artery embolisation, and umbilical artery injection, are disturbances of the blood supply or toxic mechanisms. The ischaemic genesis of spinal cord damage is obvious in the case of vessel ligatures or cross-clamping of the aorta with resulting hypotonic discirculation. In radiomyelopathy as well, the damage to the spinal vessels outweighs the direct neuronal damage. Corresponding to the vascular cause, lesions are more likely to occur at the level of borderlines of blood supply in the middle thoracic cord or in the area of a non-anastomosed great radicular artery in the lumbar spinal cord. Knowledge of the consequences and side eects of medical treatment is imperative. Knowing about the risk of a paraplegic lesion, we need a strict indication for diagnostic and therapeutic interventions. Due to progress in science some of the reasons of iatrogenic paraplegia have become manageable. Especially in radiotherapy, vascular surgery and angiography the risk of neurological complications has been lowered.

Celiac Plexus, Splanchnic Nerve Block, and Neurolysis

“…This study reported four complications, including asymptomatic hypotension after neurolysis, retroperitoneal abscess after celiac plexus block, and severe self-limited post-procedural pain in two patients after celiac plexus block [ 50 ] . Reports of retroperitoneal bleed and abscess [ 51 ] , urinary retention [ 36 ] , hiccoughing [ 52 ] , bowel perforation, gastroparesis [ 53 ] , hemorrhagic gastritis [ 54 ] , loss of anal and bladder sphincter function [ 42 ] , ejaculatory failure [ 55 ] , anterior spinal artery syndrome and paraplegia [ 27,30,44 ] , aortic dissection [ 56 ] , and aortic pseudoaneurysm [ 57 ] have also been described.…”

“…The neurolytic-induced vasospasm of the artery of Adamkiewicz may occur secondary to compromised perfusion due to surrounding tissue edema or by direct contraction of the arterial muscle wall [45][46][47] . Paraplegia may also result from direct injection of neurolytic agents into the artery of Adamkiewicz or radicular artery [ 27,29,44,48 ] . Even when CPB neurolysis has been performed under direct visualization by an open anterior approach, paraplegia has been a complication likely because of the close anatomical proximity of the celiac plexus to the artery of Adamkiewicz [ 49 ] .…”

“…The intravascular spread of the neurolytic solution to the spinal cord may occur with any paraspinal block using neurolytics [ 13,[27][28][29][30][31][32][33] . Even with direct intraoperative visualization, administration of a neurolytic has been reported to lead to permanent paraplegia [ 13 ] .…”

Risk Factors of Iatrogenic Spinal Cord Injury in Spinal Surgery: A Multicenter Retrospective Study

“…In the clinical work, many iatrogenic reasons, especially spinal injury, may cause SCI. Bacher's study [3] showed that 42.8% (9/21) patients with iatrogenic SCI were related to operations close to the spinal cord, and the remaining 57.2% (12/21) were caused by ischemia or toxin mechanisms. There iatorgenic injuries were unexpected in most cases.…”

Cervical Transforaminal Injection and the Radicular Artery: Variation in Anatomical Location Within the Cervical Intervertebral Foramina

“…Direct injection of foreign sub-stances into the radicular arteries may also lead to spinal-cord infarction and paraplegia. 2,3 Several recent articles have detailed the adverse events associated with transforaminal steroid injections, including rare but catastrophic spinal-cord infarction and death. [4][5][6] Current data are insufficient to allow estimation of the incidence and prevalence of these catastrophic complications, but several recent reports have proposed guidelines for cervical transforaminal steroid injections.…”