Iatrogenic spinal cord ischemia: A patient level meta-analysis of 74 case reports and series

North American Spine Society Journal, 2021 · DOI: https://doi.org/10.1016/j.xnsj.2021.100080 · Published: September 28, 2021

Spinal Cord Injury Healthcare Research Methodology & Design

Simple Explanation

Iatrogenic spinal cord ischemia (ISCI) is a rare but serious complication following surgical procedures, particularly those involving the aorta and spine. This study aims to understand the characteristics of ISCI and identify effective treatment strategies. The study involves a meta-analysis of 74 case reports and series to evaluate the impact of different treatments and the location of the infarction on patient outcomes. The findings indicate that certain surgical interventions and management strategies can improve outcomes, while the location of the ischemic injury also plays a significant role in determining the extent of recovery.

Study Duration

10 years

Participants

89 patients from 74 case reports and series

Evidence Level

Meta-analysis of case reports and series

Key Findings

1
Non-aortic surgeries were associated with significantly poorer overall outcomes compared to aortic and endovascular surgeries.
2
Surgical intervention after infarction was associated with a significant improvement in outcomes.
3
Autonomic impairment was associated with increased frequency of injury at the T10 spinal level.

Research Summary

This meta-analysis of 74 case reports and series characterizes iatrogenic spinal cord ischemia (ISCI), evaluates treatment strategies, and compares outcomes based on infarction location. The study reveals that aortic and endovascular surgeries have improved discharge outcomes, while non-aortic surgeries have poorer overall outcomes. Surgical intervention post-infarction improves outcomes. The location of infarction influences outcomes, with injuries at T4-T7 and T10 associated with poorer results. The study highlights the need for randomized controlled trials to test treatment strategies.

Practical Implications

Improved Treatment Protocols

The study suggests that incorporating blood pressure management strategies, frequently used in aortic surgery, into post-SCI management for non-surgical procedures and non-aortic surgeries may be effective.

Rehabilitation Evaluation

Better tools and metrics are needed to evaluate which patients would benefit from rehabilitation programs, as rehabilitation was associated with worse outcomes in some subgroups.

Further Investigation of Therapies

Further investigation, in the form of prospective observational studies, is needed for rarely reported therapeutic strategies like hyperbaric oxygen and hemoglobin transfusion, which showed promising outcomes.

Study Limitations

1
Case reports and series are considered the lowest tier of evidence and a source of publication bias.
2
Lack of widely used treatment algorithms and single-center retrospective studies are subject to selection bias.
3
Heterogeneity in data due to variable reporting of SCI across different inciting factors.

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