Orthostatic Hypotension Following Cervical Spine Surgery: Prevalence and Risk Factors

Abstract

Study Design: Retrospective case series.Objectives: This study aims to determine the prevalence and risk factors for orthostatic hypotension (OH) in patients undergoing cervical spine surgery.Methods: Data was collected from records of 190 consecutive patients who underwent cervical spine procedures at our center over 24 months. Statistical comparison was made between patients who developed postoperative OH and those who did not by analyzing characteristics such as age, gender, premorbid medical comorbidities, functional status, mechanism of spinal cord injury, preoperative neurological function, surgical approach, estimated blood loss, and length of stay.Results: Twenty-two of 190 patients (11.6%) developed OH postoperatively. No significant differences in age, gender, medical comorbidities, or premorbid functional status were observed. Based on univariate comparisons, traumatic mechanism of injury (P ¼ .002), poor ASIA (American Spinal Injury Association) grades (A, B, or C) (P < .001), and posterior surgical approach (P ¼ .045) were found to significantly influence occurrence of OH. Among the significant variables, after adjusting for mechanism of injury and surgical approach, only ASIA grade was found to be an independent predictor. Having an ASIA grade of A, B, or C increased the likelihood of developing OH by approximately 5.978 times (P ¼ .003). Conclusion:Our study highlights that OH is not an uncommon manifestation following cervical spine surgery. Patients with poorer ASIA grades A, B, or C were more likely to have OH when compared with those with ASIA grades D or E (43.5% vs 7.2%). Hence, we suggest that postural blood pressure should be routinely monitored in this group of patients so that early intervention can be initiated.

Orthostatic Hypotension Following Posterior Spinal Fusion Surgeries for Spinal Deformity Correction in Adolescents: Prevalence and Risk Factors

“…The risk factors for postoperative OH following spine surgeries remain unclear. Neurological de cits and traumatic SCI have been reported to be associated with a higher incidence of postoperative OH (3). In our study, we found that age, sex, the number of levels instrumented and fused, whether laminectomy or osteotomy was performed during the surgery, the postoperative hemoglobin level and the postoperative albumin level were not signi cantly associated with postoperative OH following posterior spinal fusion surgeries for the correction of spinal deformities in adolescent patients.…”

“…Edward et al found that 22 of 190 patients who underwent cervical spine surgery (11.6%) developed postoperative OH. The authors found that the presence of neurological de cits is a risk factor for postoperative OH (3). The link between spinal cord injuries (SCIs) and the development of OH has been observed (15).…”

“…It is de ned as a decrease in the systolic blood pressure (BP) by more than 20 mmHg or a decrease in the diastolic BP be more than 10 mmHg from the baseline BP within 3 minutes of changing the body position from a supine position to an upright posture (1). Postoperative OH is a common manifestation following various surgeries, and its etiology is multifactorial and may vary according to the type of surgery (2,3). Postoperative OH is often characterized by symptoms of syncope, dizziness, and light headedness.…”

“…However, weakness, fatigue, cognitive issues, visual blurring, headache, neck pain, orthostatic dyspnea, or chest pain caused by OH may also occur in some patients and make patients distressed, potentially delaying recovery after surgery (4,5). An association between OH and many types of surgeries, including cervical spine surgery, has been reported (3,6,7). However, to date, no studies have studied the association between OH and posterior spinal fusion surgeries for the treatment of adolescent spinal deformities.…”

Orthostatic hypotension following posterior spinal fusion surgeries for spinal deformity correction in adolescents: prevalence and risk factors

“…It is defined as a decrease in the systolic blood pressure (BP) by more than 20 mmHg or a decrease in the diastolic BP be more than 10 mmHg from the baseline BP within 3 min of changing the body position from a supine position to an upright posture [ 1 ]. Postoperative OH is a common manifestation following various surgeries, and its etiology is multifactorial and may vary according to the type of surgery [ 2 , 3 ]. Postoperative OH is often characterized by symptoms of syncope, dizziness, and light headedness.…”