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Perioperative Cerebrovascular Accidents in Spine Surgery: A Retrospective Descriptive Study and A Systematic Review with Meta-Analysis – Lumbar Spinal Stenosis

The article focuses on the occurrence of perioperative cerebrovascular accidents (CVAs) related to spine surgery, which although rare, can result in significant disabilities. A retrospective descriptive study and meta-analysis were conducted to assess the characteristics and outcomes of patients who experienced CVAs during spine surgery. The study included 2,346 patients who underwent spine surgery between April 2011 and March 2023, with 4 patients (0.17%) experiencing perioperative CVAs. The meta-analysis identified risk factors for CVAs during spine surgery, such as cervical level, hypertension, atrial fibrillation, heart disease, and diabetes. The findings emphasize the importance of risk assessment, preoperative optimization, and postoperative care to reduce the risk of perioperative CVAs associated with spine surgery

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most specialised treatment hospital in London

Published article

CONCLUSIONS: It was speculated that the potential risk factors for the four perioperative CVA cases of spine surgery in this retrospective descriptive study were intraoperative dural injury, preoperative anticoagulant discontinuation, and gestational hypertension history. The meta-analysis revealed that cervical spine surgery, hypertension, atrial fibrillation, heart disease, and diabetes increased the CVA risk. This highlights the need for risk assessment, preoperative optimization, and…

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Spine Surg Relat Res. 2023 Dec 27;8(2):171-179. doi: 10.22603/ssrr.2023-0213. eCollection 2024 Mar 27. ABSTRACT INTRODUCTION: Perioperative cerebrovascular accidents (CVAs) related to spine surgery, although rare, can lead to significant disabilities. More studies on spine surgeries are required to identify those at risk of perioperative CVAs. The characteristics and outcomes of patients that experienced CVAs during,

Spine Surg Relat Res. 2023 Dec 27;8(2):171-179. doi: 10.22603/ssrr.2023-0213. eCollection 2024 Mar 27.

ABSTRACT

INTRODUCTION: Perioperative cerebrovascular accidents (CVAs) related to spine surgery, although rare, can lead to significant disabilities. More studies on spine surgeries are required to identify those at risk of perioperative CVAs. The characteristics and outcomes of patients that experienced CVAs during spine surgery were assessed through a retrospective descriptive study and meta-analysis.

METHODS: Patients aged ≥18 years who underwent spine surgery under general anesthesia at a hospital between April 2011 and March 2023 were examined. Of the 2,391 initially identified patients, 2,346 were included after excluding 45 who underwent debridement for surgical site infections. Subsequently, a meta-analysis including the present retrospective descriptive study was conducted. Databases such as PubMed and Google Scholar were searched for original peer-reviewed articles written in English.

RESULTS: Of the 2,346 patients, 4 (0.17%) (three men, one woman) exhibited perioperative CVAs associated with spine surgery. The CVAs were diverse in nature: one case of cerebral hemorrhage resulting from dural injury during posterior occipitocervical fusion, two cases of cerebral infarctions after lumbar laminectomy and anterior thoracic fusion due to anticoagulant discontinuation, and one case of posterior reversible encephalopathy syndrome following microscopic lumbar discectomy due to gestational hypertension. The subsequent meta-analysis included three studies (n=186,860). It showed several risk factors for perioperative CVAs, including cervical level (pooled odds ratio [OR]=1.33), hypertension (pooled OR=2.27), atrial fibrillation (pooled OR=8.78), history of heart disease (pooled OR=2.47), and diabetes (pooled OR=2.13).

CONCLUSIONS: It was speculated that the potential risk factors for the four perioperative CVA cases of spine surgery in this retrospective descriptive study were intraoperative dural injury, preoperative anticoagulant discontinuation, and gestational hypertension history. The meta-analysis revealed that cervical spine surgery, hypertension, atrial fibrillation, heart disease, and diabetes increased the CVA risk. This highlights the need for risk assessment, preoperative optimization, and postoperative care to reduce spine surgery-associated perioperative CVAs.

PMID:38618211 | PMC:PMC11007245 | DOI:10.22603/ssrr.2023-0213

The London Spine Unit : most specialised treatment hospital in London

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Perioperative Cerebrovascular Accidents in Spine Surgery: A Retrospective Descriptive Study and A Systematic Review with Meta-Analysis

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Spine Surg Relat Res. 2023 Dec 27;8(2):171-179. doi: 10.22603/ssrr.2023-0213. eCollection 2024 Mar 27. ABSTRACT INTRODUCTION: Perioperative cerebrovascular accidents (CVAs) related to spine surgery, although rare, can lead to significant disabilities. More studies on spine surgeries are required to identify those at risk of perioperative CVAs. The characteristics and outcomes of patients that experienced CVAs during
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