Worsening of Neurologic Symptoms After Spinal Anesthesia in Two Patients With Spinal Stenosis

Kopp, Sandra L.; Peters, Shannon M.; Rose, Peter S.; Hebl, James R.; Horlocker, Terese T.

doi:10.1097/aap.0000000000000203

Cited by 9 publications

(7 citation statements)

References 25 publications

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“…54 In the study by Hebl et al, 53 4 of the 10 patients who developed new deficits or complained of progression of their deficits after neuraxial anesthesia suffered from spinal stenosis. The patients' symptoms may have been related to progression of their stenosis.…”

Section: Worsening Of Back Pain After Neuraxial Anesthesiamentioning

confidence: 98%

Back Pain and Neuraxial Anesthesia

Benzon

Asher

Hartrick

2016

Anesthesia &Amp; Analgesia

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The incidence of back pain after neuraxial anesthesia in the adult population is not different from that after general anesthesia. The pain is usually mild, localized in the low back, rarely radiates to the lower extremities, and has a duration of only a few days. The risk factors for development of back pain include the lithotomy position, multiple attempts at block placement, duration of surgery longer than 2.5 hours, body mass index ≥32 kg/m, and a history of back pain. However, there is no permanent worsening of preexisting back pain after neuraxial anesthesia. The back pain has been attributed to tears in the ligaments, fascia, or bone with localized bleeding; immobility of the spine; relaxation of the paraspinal muscles under anesthesia; flattening of the normal lumbar convexity; and stretching and straining of the lumbosacral ligaments and joint capsules. The addition of an anti-inflammatory drug to the local anesthetic used for skin infiltration may decrease the incidence and severity of back pain. The use of spinal or epidural anesthesia in the adult, non-obstetric and obstetric populations should depend on the advantages offered by the technique and not on the occurrence of back pain after the procedure. Additional studies are needed to confirm the efficacy of epidural dexamethasone, or other steroids, or the addition of an anti-inflammatory drug to the local anesthetic infiltration for the prevention of back pain after neuraxial anesthesia. Future studies should involve a physician with expertise in the evaluation of chronic low back pain to help identify the cause of the back pain and institute appropriate treatment(s).

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Section: Worsening Of Back Pain After Neuraxial Anesthesiamentioning

confidence: 98%

Back Pain and Neuraxial Anesthesia

Benzon

Asher

Hartrick

2016

Anesthesia &Amp; Analgesia

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“…13 Although the preponderance of these injuries have been associated with epidural or combined spinal-epidural techniques, 28 injuries have also been associated with spinal anesthesia. 58,116 As supported by a few large population studies and a multitude of case reports and series, 13 the advisory panel speculates that patients with spinal stenosis may be especially vulnerable to These recommendations are intended to encourage optimal patient care but cannot ensure the avoidance of adverse outcomes. As with any practice advisory recommendation, these are subject to revision as knowledge advances regarding specific complications.…”

Section: Spinal Stenosismentioning

confidence: 99%

The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine

Neal¹,

Barrington

Brull

et al. 2015

Regional Anesthesia and Pain Medicine

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377

240

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The Second American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine updates information that was originally presented at the Society's first open forum on this subject (2005) and published in 2008. Portions of the second advisory were presented in an open forum (2012) and are herein updated, with attention to those topics subject to evolving knowledge since the first and second advisory conferences. The second advisory briefly summarizes recommendations that have not changed substantially. New to this iteration of the advisory is information related to the risk of nerve injury inherent to common orthopedic surgical procedures. Recommendations are expanded regarding the preventive role of various monitoring technologies such as ultrasound guidance and injection pressure monitoring. New clinical recommendations focus on emerging concerns including spinal stenosis and vertebral canal pathologies, blood pressure management during neuraxial anesthesia, administering blocks in anesthetized or deeply sedated patients, patients with preexisting neurologic disease, and inflammatory neuropathies. An updated diagnostic and treatment algorithm is presented.

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“…It is rarely caused by congenital malformations. Pre‐existing stenosis may contribute to spinal cord injury because the narrower canal cross‐sectional area in such patients renders them more at risk of nerve compression or local anaesthetic neurotoxicity . The severity of a given injury in these patients may also be higher compared with the general population .…”

Section: Pathophysiology Of Spinal Cord Injurymentioning

confidence: 99%

Spinal cord injury arising in anaesthesia practice

2018

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SummarySpinal cord injury arising during anaesthetic practice is a rare event, but one that carries a significant burden in terms of morbidity and mortality. In this article, we will review the pathophysiology of spinal cord injury. We will then discuss injuries relating to patient position, spinal cord hypoperfusion and neuraxial techniques. The most serious causes of spinal cord injury -vertebral canal haematoma, spinal epidural abscess, meningitis and adhesive arachnoiditis -will be discussed in turn. For each condition, we draw attention to practical, evidence-based measures clinicians can undertake to reduce their incidence, or mitigate their severity. Finally, we will discuss transient neurological symptoms. Some cases of spinal cord injury during anaesthesia can be ascribed to anaesthesia itself, arising as a direct consequence of its conduct. The injury to a spinal nerve root by inaccurate and/or incautious needling during spinal anaesthesia is an obvious example. But in many cases, spinal cord injury during anaesthesia is not caused by, related to, or even associated with, the conduct of the anaesthetic. Surgical factors, whether direct (e.g. spinal nerve root damage due to incorrect pedicle screw placement) or indirect (e.g. cord ischaemia following aortic surgery) are responsible for a significant proportion of spinal cord injuries that occur concurrently with the delivery of regional or general anaesthesia. Pathophysiology of spinal cord injuryInjury to the spinal cord and its nerve roots occurs following a range of insults, including: compression; stretch; hypoperfusion; direct trauma; exposure to neurotoxic material; or a combination of these factors. Like peripheral nerves, the spinal cord responds poorly to ischaemia, which is the common histopathological endpoint of these insults.In contrast to peripheral nerve injury during anaesthesia, many cases of spinal cord injury have a clear aetiology. Certain predispositions may render patients more at risk of spinal cord injury during anaesthesia, including: spinal canal deformity; abnormal coagulation; abnormal vascular supply; or immunosuppression.Spinal canal stenosis is a common spinal canal deformity and can result from arthritic change, ankylosing spondylitis, Paget's disease or acromegaly. It is rarely caused by congenital malformations. Pre-existing stenosis may contribute to spinal cord injury because the narrower canal cross-sectional area in such patients renders them more at risk of nerve compression or

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Worsening of Neurologic Symptoms After Spinal Anesthesia in Two Patients With Spinal Stenosis

Cited by 9 publications

References 25 publications

Back Pain and Neuraxial Anesthesia

Back Pain and Neuraxial Anesthesia

The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine

Spinal cord injury arising in anaesthesia practice

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