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Global Spine J. 2017 Apr;7(1 Suppl):84S-90S. doi: 10.1177/2192568216688188. Epub 2017 Apr 1.

Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery.

Author information

1
Brown University, Providence, RI, USA.
2
Oregon Health & Science University, Portland, OR, USA.
3
Jefferson Medical College, The Rothman Institute, Philadelphia, PA, USA.
4
University of California Los Angeles, Santa Monica, CA, USA.
5
USC Spine Center, Los Angeles, CA, USA.
6
University of Southern California, Los Angeles, CA, USA.
7
Medstar Union Memorial Hospital, Baltimore, MD, USA.
8
Johns Hopkins Medical Institutions, Baltimore, MD, USA.
9
Mayo Clinic, Rochester, MN, USA.
10
Kansas University Medical Center, Kansas City, KS, USA.
11
Toronto Western Hospital, Toronto, Ontario, Canada.
12
Cleveland Clinic, Cleveland, OH, USA.
13
Columbia University, New York, NY, USA.
14
New York-Presbyterian/The Allen Hospital, New York, NY, USA.

Abstract

STUDY DESIGN:

Retrospective cohort study of prospectively collected data.

OBJECTIVE:

To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery.

METHODS:

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‚ÄČ625 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.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

cervical spine surgery; complication; iatrogenic spinal cord injury; quadriplegia

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Alan H. Daniels reports grants from AOSpine North America during the conduct of the study, personal fees from Stryker, personal fees from Depuy, other from Globus, nonfinancial support from Medtronic, outside the submitted work; Robert A. Hart reports grants from AOSpine North America during the conduct of the study, other from CSRS Board, other from ISSLS, other from ISSG Executive Commitee, personal fees from DepuySynthes, personal fees from Globus, personal fees from Medtronic, other from Evans, Craven & Lackie, other from Benson, Bertoldo, Baker, & Carter, grants from Medtronic, grants from ISSGF, personal fees from Seaspine, personal fees from DepuySynthes, other from Spine Connect, personal fees from DepuySynthes, outside the submitted work; Alan S. Hilibrand reports grants from AOSpine North America during the conduct of the study, other from Amedica, Vertiflex, Benvenue, Lifespine, Paradigm Spine, PSD, Spinal Ventures, outside the submitted work, and in addition, Dr. Hilibrand has a patent Aesculap, Amedica, Biomet, Stryker, Alphatec, with royalties paid; David E. Fish reports grants from AOSpine North America during the conduct of the study; Jeffrey C. Wang reports grants from AOSpine North America during the conduct of the study; Elizabeth L. Lord reports grants from AOSpine North America during the conduct of the study; Zorica Buser reports grants from AOSpine North America during the conduct of the study; P. Justin Tortolani reports grants from AOSpine North America during the conduct of the study, other from Globus Medical, grants from Spineology, other from Innovasis, outside the submitted work, and in addition, Dr. Tortolani has a patent Globus with royalties paid; D. Alex Stroh reports grants from AOSpine North America during the conduct of the study; Ahmad Nassr reports grants from AOSpine North America during the conduct of the study; Bradford L. Currier reports grants from AOSpine North America during the conduct of the study, personal fees from DePuy Spine, personal fees from Stryker Spine, personal fees from Zimmer Spine, other from Zimmer Spine, other from Tenex, other from Spinology, other from LSRS, other from AOSNA, outside the submitted work; Arjun S. Sebastian reports grants from AOSpine North America during the conduct of the study; Michael G. Fehlings reports grants from AOSpine North America during the conduct of the study; Thomas E. Mroz reports other from AOSpine, grants from AOSpine North America during the conduct of the study, personal fees from Stryker, personal fees from Ceramtec, other from Pearl Diver, outside the submitted work; K. Daniel Riew reports personal fees from AOSpine International, other from Global Spine Journal, other from Spine Journal, other from Neurosurgery, personal fees from Multiple Entities for defense, plantiff, grants from AOSpine, grants from Cerapedics, grants from Medtronic, personal fees from AOSpine, personal fees from NASS, personal fees from Biomet, personal fees from Medtronic, nonfinancial support from Broadwater, outside the submitted workPaul M. Arnold reports grants from AOSpine North America during the conduct of the study; other from Z-Plasty, other from Medtronic Sofamore Danek, other from Stryker Spine, other from FzioMed, other from AOSpine North America, other from Life Spine, other from Integra Life, other from Spine Wave, other from MIEMS, other from Cerapedics, other from AOSpine North America, outside the submitted work.

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