Iatrogenic spinal cord injury resulting from cervical Spine surgery

Alan H. Daniels, Robert A. Hart, Alan S. Hilibrand, David E. Fish, Jeffrey C. Wang, Elizabeth L. Lord, Zorica Buser, P. Justin Tortolani, D. Alex Stroh, Ahmad Nassr, Bradford L. Currier, Arjun S. Sebastian, Paul M. Arnold, Michael G. Fehlings, Thomas E. Mroz, K. Daniel Riew

Research output: Contribution to journalArticle

Abstract

Study Design: Retrospective cohort study of prospectively collected data. Objective: To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery. Methods: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was conducted. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of iatrogenic spinal cord injury. Results: In total, 3 cases of iatrogenic spinal cord injury following cervical spine surgery were identified. Institutional incidence rates ranged from 0.0% to 0.24%. Of the 3 patients with quadriplegia, one underwent anterior-only surgery with 2-level cervical corpectomy, one underwent anterior surgery with corpectomy in addition to posterior surgery, and one underwent posterior decompression and fusion surgery alone. One patient had complete neurologic recovery, one partially recovered, and one did not recover motor function. Conclusion: Iatrogenic spinal cord injury following cervical spine surgery is a rare and devastating adverse event. No standard protocol exists that can guarantee prevention of this complication, and there is a lack of consensus regarding evaluation and treatment when it does occur. Emergent imaging with magnetic resonance imaging or computed tomography myelography to evaluate for compressive etiology or malpositioned instrumentation and avoidance of hypotension should be performed in cases of intraoperative and postoperative spinal cord injury.

Original languageEnglish (US)
Pages (from-to)84S-90S
JournalGlobal Spine Journal
Volume7
Issue number1_suppl
DOIs
StatePublished - Apr 1 2017

Fingerprint

Spinal Cord Injuries
Spine
Myelography
Quadriplegia
Incidence
North America
Decompression
Hypotension
Nervous System
Medical Records
Cohort Studies
Retrospective Studies
Tomography
Magnetic Resonance Imaging
Research

Keywords

  • cervical spine surgery
  • complication
  • iatrogenic spinal cord injury
  • quadriplegia

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Daniels, A. H., Hart, R. A., Hilibrand, A. S., Fish, D. E., Wang, J. C., Lord, E. L., ... Riew, K. D. (2017). Iatrogenic spinal cord injury resulting from cervical Spine surgery. Global Spine Journal, 7(1_suppl), 84S-90S. https://doi.org/10.1177/2192568216688188

Iatrogenic spinal cord injury resulting from cervical Spine surgery. / Daniels, Alan H.; Hart, Robert A.; Hilibrand, Alan S.; Fish, David E.; Wang, Jeffrey C.; Lord, Elizabeth L.; Buser, Zorica; Tortolani, P. Justin; Stroh, D. Alex; Nassr, Ahmad; Currier, Bradford L.; Sebastian, Arjun S.; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.; Riew, K. Daniel.

In: Global Spine Journal, Vol. 7, No. 1_suppl, 01.04.2017, p. 84S-90S.

Research output: Contribution to journalArticle

Daniels, AH, Hart, RA, Hilibrand, AS, Fish, DE, Wang, JC, Lord, EL, Buser, Z, Tortolani, PJ, Stroh, DA, Nassr, A, Currier, BL, Sebastian, AS, Arnold, PM, Fehlings, MG, Mroz, TE & Riew, KD 2017, 'Iatrogenic spinal cord injury resulting from cervical Spine surgery', Global Spine Journal, vol. 7, no. 1_suppl, pp. 84S-90S. https://doi.org/10.1177/2192568216688188
Daniels AH, Hart RA, Hilibrand AS, Fish DE, Wang JC, Lord EL et al. Iatrogenic spinal cord injury resulting from cervical Spine surgery. Global Spine Journal. 2017 Apr 1;7(1_suppl):84S-90S. https://doi.org/10.1177/2192568216688188
Daniels, Alan H. ; Hart, Robert A. ; Hilibrand, Alan S. ; Fish, David E. ; Wang, Jeffrey C. ; Lord, Elizabeth L. ; Buser, Zorica ; Tortolani, P. Justin ; Stroh, D. Alex ; Nassr, Ahmad ; Currier, Bradford L. ; Sebastian, Arjun S. ; Arnold, Paul M. ; Fehlings, Michael G. ; Mroz, Thomas E. ; Riew, K. Daniel. / Iatrogenic spinal cord injury resulting from cervical Spine surgery. In: Global Spine Journal. 2017 ; Vol. 7, No. 1_suppl. pp. 84S-90S.
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abstract = "Study Design: Retrospective cohort study of prospectively collected data. Objective: To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery. Methods: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was conducted. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of iatrogenic spinal cord injury. Results: In total, 3 cases of iatrogenic spinal cord injury following cervical spine surgery were identified. Institutional incidence rates ranged from 0.0{\%} to 0.24{\%}. Of the 3 patients with quadriplegia, one underwent anterior-only surgery with 2-level cervical corpectomy, one underwent anterior surgery with corpectomy in addition to posterior surgery, and one underwent posterior decompression and fusion surgery alone. One patient had complete neurologic recovery, one partially recovered, and one did not recover motor function. Conclusion: Iatrogenic spinal cord injury following cervical spine surgery is a rare and devastating adverse event. No standard protocol exists that can guarantee prevention of this complication, and there is a lack of consensus regarding evaluation and treatment when it does occur. Emergent imaging with magnetic resonance imaging or computed tomography myelography to evaluate for compressive etiology or malpositioned instrumentation and avoidance of hypotension should be performed in cases of intraoperative and postoperative spinal cord injury.",
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