Spinal neurovascular complications with anterior thoracolumbar spine surgery: a systematic review and review of thoracolumbar vascular anatomy.

Autor:	Shlobin NA; Departments of1Neurological Surgery and., Raz E; 3Departments of Radiology and Neurological Surgery, New York University Grossman School of Medicine, Bernard and Irene Schwartz Neurointerventional Radiology Section, NYU Langone Medical Center, New York, New York., Shapiro M; 3Departments of Radiology and Neurological Surgery, New York University Grossman School of Medicine, Bernard and Irene Schwartz Neurointerventional Radiology Section, NYU Langone Medical Center, New York, New York., Clark JR; Departments of1Neurological Surgery and., Hoffman SC; Departments of1Neurological Surgery and., Shaibani A; Departments of1Neurological Surgery and.; 2Radiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois; and., Hurley MC; Departments of1Neurological Surgery and.; 2Radiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois; and., Ansari SA; Departments of1Neurological Surgery and.; 2Radiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois; and., Jahromi BS; Departments of1Neurological Surgery and.; 2Radiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois; and., Dahdaleh NS; Departments of1Neurological Surgery and., Potts MB; Departments of1Neurological Surgery and.; 2Radiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois; and.
Jazyk:	angličtina
Zdroj:	Neurosurgical focus [Neurosurg Focus] 2020 Sep; Vol. 49 (3), pp. E9.
DOI:	10.3171/2020.6.FOCUS20373
Abstrakt:	Objective: Spinal cord infarction due to interruption of the spinal vascular supply during anterior thoracolumbar surgery is a rare but devastating complication. Here, the authors sought to summarize the data on this complication in terms of its incidence, risk factors, and operative considerations. They also sought to summarize the relevant spinal vascular anatomy. Methods: They performed a systematic literature review of the PubMed, Scopus, and Embase databases to identify reports of spinal cord vascular injury related to anterior thoracolumbar spine procedures as well as operative adjuncts and considerations related to management of the segmental artery ligation during such anterior procedures. Titles and abstracts were screened, and studies meeting inclusion criteria were reviewed in full. Results: Of 1200 articles identified on the initial screening, 16 met the inclusion criteria and consisted of 2 prospective cohort studies, 10 retrospective cohort studies, and 4 case reports. Four studies reported on the incidence of spinal cord ischemia with anterior thoracolumbar surgery, which ranged from 0% to 0.75%. Eight studies presented patient-level data for 13 cases of spinal cord ischemia after anterior thoracolumbar spine surgery. Proposed risk factors for vasculogenic spinal injury with anterior thoracolumbar surgery included hyperkyphosis, prior spinal deformity surgery, combined anterior-posterior procedures, left-sided approaches, operating on the concavity side of a scoliotic curve, and intra- or postoperative hypotension. In addition, eight studies analyzed operative considerations to reduce spinal cord ischemic complications in anterior thoracolumbar surgery, including intraoperative neuromonitoring and preoperative spinal angiography. Conclusions: While spinal cord infarction related to anterior thoracolumbar surgery is rare, it warrants proper consideration in the pre-, intra-, and postoperative periods. The spine surgeon must be aware of the relevant risk factors as well as the pre- and intraoperative adjuncts that can minimize these risks. Most importantly, an understanding of the relevant spinal vascular anatomy is critical to minimizing the risks associated with anterior thoracolumbar spine surgery.
Databáze:	MEDLINE
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