Thoracic Unilateral Spinal Cord Injury After Spinal Anaesthesia for Total Hip Replacement: Fate or Mistake?

Abstract

Case Report / Olgu Sunumu Spinal anestezi total kalça protezi ameliyatı için ilk seçenektir ve hafif komplikasyonlarının yanı sıra yaşamı tehdit edecek kadar ciddi komplikasyonları da vardır. Bazı spinal kord iskemisi vakaları tanımlanmış olmasına rağmen, nöroaksiyal anestezi sonrasında nörolojik komplikasyonların insidansı net değildir. Bu çalışmada, total kalça protezi için L2-L3 spinal anestezi uygulamasının ardın-dan gelişen tek taraflı T8-T11 spinal kord iskemi vakası sunulmaktadır. Manyetik rezonans görüntülemesi (MRI) sonucunda, sol paramediyan spinal kord hiperintens T8-T11 sinyal değişikliği bulundu. Hasar ile cerrahi arasında geçici bir epidemiyolojik bağ-lantının varlığı görülmektedir. Yaralanma, yara alanı ile spinal iğ-nenin giriş alanı arasında, anatomik yakınlık olmaksızın meydana geldi. Bu durum, sadece birinin yaralanmayı tek başına belirlemek için yeterli olmayacağı birçok faktörden kaynaklanabilir. Aynı anda hepsinin etkisiyle komplikasyon oluşabilir. Çalışmamızda sonuç öngörülemez ve kaçınılmazdı. Yetersiz tıbbi uygulamadan ziyade beklenmeyen durumlar bu sonuca yol açtılar.Anahtar kelimeler: Spinal kord yaralanmaları, spinal anestezi, kalça protezi artroplastisi, spinal kord iskemisi, iskemik miyelopati Spinal anaesthesia is the most preffered anesthesia technique for total hip replacement, and its complications range from low entity (insignificant) to life threatening. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear, although there are several described cases of spinal cord ischaemia. We present a case of unilateral T8-T11 spinal cord ischaemia following L2-L3 spinal anaesthesia for total hip replacement. Magnetic resonance imaging showed a hyperintense T8-T11 signal alteration on the leftside of paramedian spinal cord. A temporal epidemiologic linkage between the damage and the surgery seems to be present. The injury occurred without anatomical proximity between the injury site and the spinal needle entry site. This may be due to multiple contributing factors, each of them is probably not enough to determine the damage by itself; however, acting simultaneously, they could have been responsible for the complication. The result was unpredictable and unavoidable and was caused by unforeseeable circumstances and not by inadequate medical practice.Keywords: Spinal cord injuries, spinal anaesthesia, arthroplasty, hip replacement, spinal cord ischaemia, ischaemic myelopathy Abstract / Öz

Thoracic Unilateral Spinal Cord Syndrome Following Neuraxial Anaesthesia for Periprosthetic Knee Fracture: A Case Report

“…If this artery is occluded, there will be ischemia of the lower two-thirds of the spinal cord. Although there is wide variability in the spinal cord blood supply, we may observe unilateral muscle paralysis with unilateral spinal cord ischemia due to this artery occlusion [1].…”

“…If there is no contraindication, neuraxial techniques conform to the anaesthetic management of this patient. Its complications range from low entity (insignificant) to life threatening [1] [2] [3].…”

“…MNR a week later showing less intra-cord hyperintensity.infections, less incidence of deep venous thrombosis and a reduction in blood loss compared to general anaesthesia; decreased 30-day morbidity is not clear though[5] [6] [7][8].The incidence of postoperative neurological complications after neuraxial anaesthesia stands between 0% -0.08%[1]. Carpenter et al performed a study in which they analyzed the incidence of hypotension (33%), bradycardia (13%), nausea (18%), vomiting (7%) and dysrhythmia (2%).…”

Accidental Spinal Cord Injury Following an Attempted Thoracic Epidural for acute Pancreatitis Pain Management

“…Spinal cord damage can result from needle or catheter trauma, local anaesthetic toxicity, epidural or subdural haematoma, ischaemia from an arterial injury, or severe hypotension (5,6).…”