Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery.
Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery.
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DOI：
10.1177/2192568216688188
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发表时间：
2017-04
影响因子：
2.4
通讯作者：
Riew KD
中科院分区：
文献类型：
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作者：
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
前瞻性收集数据的回顾性队列研究。研究择期颈椎手术后医源性脊髓损伤的发生率。进行了一项回顾性多中心病例系列研究，涉及来自AOSpine北美临床研究网络的21个高容量手术中心。对2005年1月1日至2011年12月31日期间接受颈椎手术（C2至C7节段）的17625例患者的病历进行了审查，以确定医源性脊髓损伤的发生率。共发现3例颈椎手术后医源性脊髓损伤。机构发病率范围为0.0%至0.24%。在3例四肢瘫痪患者中，1例仅接受前路手术并进行双节段颈椎椎体次全切除术，1例在后路手术的基础上接受前路手术并进行椎体次全切除术，1例仅接受后路减压融合术。1例患者神经功能完全恢复，1例部分恢复，1例未恢复运动功能。颈椎手术后的医源性脊髓损伤是一种罕见的和毁灭性的不良事件。没有标准方案可以保证预防这种并发症，并且对于发生时的评估和治疗也缺乏共识。在术中和术后脊髓损伤的情况下，应使用磁共振成像或计算机断层扫描脊髓造影进行紧急成像，以评估压迫病因或错位器械，并避免低血压。
Retrospective cohort study of prospectively collected data. To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery. 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. 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. 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.