Anatomy and Pathophysiology of Spinal Cord Injury Associated With Regional Anesthesia and Pain Medicine

Neal, Joseph M.

doi:10.1016/j.rapm.2006.10.014

Cited by 22 publications

(35 citation statements)

References 92 publications

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“…The American Society of Regional Anesthesia and Pain Medicine's practice advisory from 2015 suggests maintaining blood pressure within 20% to 30% of baseline, 12 although various different definitions have been described in previous studies. For example, in a study of shoulder arthroscopy patients, YaDeau et al 13 defined hypotension by several combined criteria: a decline in MAP by more than 30%, a systolic blood pressure of less than 90 mm Hg, and/or MAP of less than 66 mm Hg.…”

Section: Outcomes and Exposuresmentioning

confidence: 99%

Lack of Association Between Levels and Length of Intraoperative Controlled Hypotension and Acute Kidney Injury in Total Hip Arthroplasty Patients Receiving Neuraxial Anesthesia

Weinstein

YaDeau

Memtsoudis

2018

Regional Anesthesia and Pain Medicine

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Section: Outcomes and Exposuresmentioning

confidence: 99%

Lack of Association Between Levels and Length of Intraoperative Controlled Hypotension and Acute Kidney Injury in Total Hip Arthroplasty Patients Receiving Neuraxial Anesthesia

Weinstein

YaDeau

Memtsoudis

2018

Regional Anesthesia and Pain Medicine

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“…10 In our 3 cases, however, direct puncture of the cord seems unlikely. In case 1, the needle was directed in an orientation (posterior, parasagittal approach) in which vertebral bone would have blocked entry into the central canal.…”

Section: Discussionmentioning

confidence: 63%

Cervical Myelopathy Caused by Injections into the Neck

Ralph

Malik

Layzer

2014

The Neurohospitalist

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Three cases of longitudinally extensive cervical myelopathies temporally associated with neck injections are presented. The spinal cord injury was similar radiographically, despite a number of different needle approaches and substances injected. In recent years, there have been reports of an acute cervical myelopathy immediately following an injection procedure in the neck. Various explanations have been offered for this unfortunate complication, including (1) direct injection into the cord leading to traumatic injury, (2) injection of particulate matter into the arterial supply of the cord causing microvascular embolism and spinal cord infarction, and (3) intraneural injection of the chemical with centripetal spread of the injectant from the nerve trunk to the substance of the cord. The merits of each of these 3 mechanisms in explaining these cases are discussed. Albeit rare, acute cervical myelopathy should be considered a potential complication from any deep injection of chemicals into the neck.

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“…Both have a rapid onset (3-5 min after puncture) and potentially last longer than muscular blockade. There is no pressure cut-off for SC ischaemia, but the risk increases if the systolic pressure falls below 60-80 mmHg (11).…”

Section: Discussionmentioning

confidence: 99%

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

Costa¹,

Romualdo²,

Eugenio³

et al. 2017

Turk J Anaesth Reanim

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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

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Anatomy and Pathophysiology of Spinal Cord Injury Associated With Regional Anesthesia and Pain Medicine

Cited by 22 publications

References 92 publications

Lack of Association Between Levels and Length of Intraoperative Controlled Hypotension and Acute Kidney Injury in Total Hip Arthroplasty Patients Receiving Neuraxial Anesthesia

Lack of Association Between Levels and Length of Intraoperative Controlled Hypotension and Acute Kidney Injury in Total Hip Arthroplasty Patients Receiving Neuraxial Anesthesia

Cervical Myelopathy Caused by Injections into the Neck

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

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