Available online 23 December 2012
Publication year: 2012
Source:World Neurosurgery
Objective Spinal cord infarction is a rare cause of neurologic deterioration after cervical spine decompressive surgery. Proposed causes of ischemic events include intraoperative or postoperative hypotension, or decreased venous return in conjunction with elevated vertebral venous pressures, which reduces arterial perfusion when patients undergo surgery in the prone position. Neuro-imaging is pivotal to exclude reversible causes for neurologic changes and confirmation of spinal cord infarction. We report five patients who underwent cervical decompressive surgeries and developed persistent postoperative neurological deficits compatible with spinal cord infarctions and evaluate causes for these rare complications. Methods The clinical courses and imaging studies of five patients were retrospectively analyzed. Imaging findings, types of surgeries, vascular compromise or risk factors, hypotensive episodes, intraoperative somatosensory evoked potentials, concomitant brain infarctions, and clinical degree and radiographic extent of spinal cord infarction were studied. Spinal cord infarctions were determined by clinical courses and imaging evaluations. Results All five patients had antecedent cervical cord region vascular compromise or generalized vascular risk factors. Four patients developed hypotensive episodes: two intraoperatively and two postoperatively. None of the four patients with hypotensive episodes had imaging or clinical evidence of concomitant brain infarctions. Conclusions The neuroimaging evaluation of spinal cord infarction after decompressive surgery is to exclude spinal cord compression, to ensure adequate surgical decompression, and to confirm infarction by imaging. The authors propose that antecedent, unrecognized preoperative vascular compromise may be a significant contributor to spinal cord infarction by itself, or in combination with hypotension.
Júlio Leonardo B. Pereira
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