Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery.

Authors

Alan H. Daniels, Brown University
Robert A. Hart, Oregon Health and Science UniversityFollow
Alan S. Hilibrand, Thomas Jefferson UniversityFollow
David E. Fish, University of California Los AngelesFollow
Jeffrey C. Wang, USC Spine CenterFollow
Elizabeth L. Lord, University of California Los AngelesFollow
Zorica Buser, University of Southern California
P. Justin Tortolani, Medstar Union Memorial Hospital; Johns Hopkins Medical InstitutionsFollow
D. Alex Stroh, Medstar Union Memorial Hospital
Ahmad Nassr, Mayo Clinic
Bradford L. Currier, Mayo ClinicFollow
Arjun S. Sebastian, Mayo Clinic
Paul M. Arnold, Kansas University Medical CenterFollow
Michael G. Fehlings, Toronto Western HospitalFollow
Thomas E. Mroz, Cleveland Clinic
K. Daniel Riew, Columbia University; New York-Presbyterian/The Allen HospitalFollow

Document Type

Article

Publication Date

4-1-2017

Comments

This article has been peer reviewed. It is the author’s final published version in Global Spine Journal

Volume 7, Issue 1, April 2017, Pages 84S-90S.

The published version is available at DOI: 10.1177/2192568216688188. Copyright © Daniels et al.

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.

Recommended Citation

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.; and Riew, K. Daniel, "Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery." (2017). Rothman Institute Faculty Papers. Paper 85.
https://jdc.jefferson.edu/rothman_institute/85

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