Spinal Cord Injury During Spinal Surgery

Abstract

Perioperative spinal cord injury (SCI) is a devastating complication, and its reported incidence can vary from 0 to 3%, depending on the pathological profiles and surgical approach. Its incidence seems to be especially high after spinal surgery, such as spinal stabilization following trauma or neoplastic disease, or correction of scoliosis. The neuronal/axonal injury can result in motor, sensory, and/or autonomic impairment. In addition to a direct insult to the spinal cord by surgical procedure, anesthesia-related factors can also deteriorate SCI, which is pre- and intraoperatively developed. In order to improve neurological outcome after spinal and spine surgery, prevention, identification, and treatment of SCI is critical. Maintenance of mean arterial pressure (MAP), application of methylpredonisolone, and neuromonitoring, including somatosensory-evoked potential (SEP) and motor-evoked potential (MEP), would be important strategies. However, anesthetic and neuromuscular blocking agents and physiological alterations can affect the results of neuromonitoring, which may interfere with an early detection of pending SCI and consequently delay its treatment. Therefore, proper understanding of its influences on each neuromonitor can be a key for anesthetic managements to reduce the incidence and severity of SCI after spinal surgery.