Spinal reperfusion syndrome. A literature review and medicolegal implications

Abstract

Aim. To consider the diagnosis of spinal reperfusion syndrome (SRS) and its medicolegal implications. Materials and Methods. . A PRISMA guided PubMed search was performed to identify cases of possible SRS following spinal surgery. Result. Fourteen papers suggested that SRS might be the cause of neurological deterioration. In patients undergoing surgery for cervical degenerative disorders there were 7 patients who had new deficits immediately on awakening from the anaesthetic. There were 6 patients who had no new deficit immediately post-surgery with new deficits occurring within hours, or up to 3 days post-surgery. Conclusion. There is no agreed clinical definition of the SRS and the radiological abnormalities are not defined. The diagnosis of SRS can potentially be made by exclusion or inclusion. If there is a known cause of new neurological deficits intra- or immediately post-operatively, such as for example intraoperative cord injury, inadequate decompression or a haematoma, that is the probable diagnosis, not SRS. If a patient awakes with new deficits the most likely cause (if no other cause is identified) is intraoperative injury to the cord. If there is delayed deterioration with no cause identified SRS is a possible explanation. New deficits occur in 0.5 to 1.0% of patients undergoing anterior cervical spine surgery i.e. overall this is common whereas SRS is rare. The medicolegal implications are discussed.