Non-iatrogenic spinal cord ischemia

Non-iatrogenic spinal cord ischemia healthcareservices.vision

ABSTRACT

Introduction: The incidence of spinal cord infarction is approximately 0.003%. Spinal cord ischemia (SCI) is variously attributed to aortic, surgery, or injury (i.e., most commonly due to medical/surgical procedures).

Specifically, non iatrogenic SCI may be due to trauma, arteriosclerosis, spinal vascular pathologies (i.e., arteriovenous malformations and thrombotic/fibrocartilaginous emboli), chronic conditions (i.e., polycythemia vera), mechanical strain (i.e., vertebral hyperextension), transverse myelitis, infection, and/or neoplasm.

Notably, initial magnetic resonance imaging may be normal as it may take several days for SCI to appear in these studies. The treatments for non iatrogenic SCI/stroke include cerebrospinal fluid (CSF) drainage, blood pressure elevation, corticosteroids, antiplatelets/anticoagulants/thrombolytics, mannitol, naloxone, surgical revascularization, hyperbaric oxygen (HBO), and systemic hypothermia.

Here, we stratified the various etiologies and treatments available for treating non-iatrogenic SCI and correlated them with patient outcomes.

Background: Guidelines are needed to manage spinal cord infarctions. Here, we evaluated the incidence of non iatrogenic spinal ischemia, focusing on the spinal levels involved, and the relative efficacy of different management strategies.

Methods: We performed a meta-analysis of 147 patients who sustained non iatrogenic spinal cord ischemia within the past 10 years.

The most common causes of injury were idiopathic (i.e., 47% medical/surgery-related) followed by systemic/chronic conditions (23.6%) and aortic vascular pathology (20%).

Post-diagnostic treatment options included rehabilitation in 53.7% of patients, while steroids (35.37%), antiplatelets aggregates (30.61%), and anticoagulation (18.37%) were also used.

Results: Traumatic causes of spinal cord ischemia were associated with worse outcomes, while those without a clear diagnosis despite extensive work-up had better results.

At discharge, patients managed with cerebrospinal fluid (CSF) drainage had significant improvement (P = 0.04), while other therapies were not effective.

Notably, ischemia mostly occurred between the T4 and T7 levels and was associated with the worst outcomes. In this thoracic “watershed” region, thoracic cord ischemia was most likely attributed to an increased susceptibility toto cord under-perfusion in this region (P < 0.05).

Conclusion: This meta-analysis revealed a variety of etiologies for non iatrogenic typically T4-T7 spinal cord ischemia.

Several different treatment strategies may be utilized in this patient population, including CSF drainage, blood pressure elevation, corticosteroids, antiplatelets/anticoagulants/thrombolytics, mannitol, naloxone, surgical revascularization, hyperbaric oxygen, systemic hypothermia.

 

 

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