Neurologic deficits after cervical laminectomy in the prone position
Neurologic deficits after cervical laminectomy in the prone position
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DOI：
10.1097/00008506-200110000-00006
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发表时间：
2001-10-01
影响因子：
3.7
通讯作者：
Toung, TJK
中科院分区：
文献类型：
--
作者：
Bhardwaj, A;Long, DM;Toung, TJK
已知脊柱手术后会发生新的神经功能缺损。我们报告了4例颈椎脊髓神经根病患者，他们在俯卧位下接受了颈椎椎板切除术、融合术或两者同时进行，由胸部滚动支撑。三名患者在清醒时插管并定位，而第四名患者在诱导后定位。除术中出现一过性相对低血压外，均成功进行了外科手术。麻醉恢复后，所有患者均出现新的神经功能缺损。即时CT脊髓造影或手术再探查无异常。所有患者在给予大剂量类固醇和诱导高血压后逐渐改善。使用俯卧位并按压腹部可能会损害脊髓灌注并导致脊髓缺血。使用框架，防止腹部压迫，以及避免围手术期动脉低血压，是重要的在减压脊髓手术期间和之后保持足够的脊髓灌注。
New neurologic deficits are known to occur after spine surgery. We present four patients with cervical myeloradiculopathy who underwent cervical laminectomy, fusion, or both in the prone position, supported by chest rolls. Three patients were intubated and positioned while awake, whereas the fourth patient was positioned after induction. Surgeries were successfully carried out, except for transient episodes of relative hypotension intraoperatively. On recovery from anesthesia, all patients were noted to have new neurologic deficits. Immediate CT myelography or surgical reexploration was unremarkable. All patients improved gradually with administration of high-dose steroids and induction of hypertension. Use of the prone position with abdominal compression may compromise spinal cord perfusion and lead to spinal cord ischemia. The use of frames that prevent abdominal compression, as well as avoidance of perioperative arterial hypotension, is important in maintaining adequate spinal cord perfusion during and after decompressive spinal cord surgery.