Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA.
Anesthesiology. 2011 Apr;114(4):782-95. doi: 10.1097/ALN.0b013e3182104859.
The aim of this study was to characterize cervical cord, root, and bony spine claims in the American Society of Anesthesiologists Closed Claims database to formulate hypotheses regarding mechanisms of injury.
All general anesthesia claims (1970-2007) in the Closed Claims database were searched to identify cervical injuries. Three independent teams, each consisting of an anesthesiologist and neurosurgeon, used a standardized review form to extract data from claim summaries and judge probable contributors to injury.
Cervical injury claims (n = 48; mean ± SD age 47 ± 15 yr; 73% male) comprised less than 1% of all general anesthesia claims. When compared with other general anesthesia claims (19%), cervical injury claims were more often permanent and disabling (69%; P < 0.001). In addition, cord injuries (n = 37) were more severe than root and/or bony spine injuries (n = 10; P < 0.001), typically resulting in quadriplegia. Although anatomic abnormalities (e.g., cervical stenosis) were often present, cord injuries usually occurred in the absence of traumatic injury (81%) or cervical spine instability (76%). Cord injury occurred with cervical spine (65%) and noncervical spine (35%) procedures. Twenty-four percent of cord injuries were associated with the sitting position. Probable contributors to cord injury included anatomic abnormalities (81%), direct surgical complications (24% [38%, cervical spine procedures]), preprocedural symptomatic cord injury (19%), intraoperative head/neck position (19%), and airway management (11%).
Most cervical cord injuries occurred in the absence of traumatic injury, instability, and airway difficulties. Cervical spine procedures and/or sitting procedures appear to predominate. In the absence of instability, cervical spondylosis was the most common factor associated with cord injury.
本研究旨在对美国麻醉师协会的已结案索赔数据库中与颈髓、神经根和骨脊柱相关的索赔进行分析，以形成与损伤机制相关的假说。
检索已结案索赔数据库中所有的全身麻醉索赔（1970-2007 年），以确定颈椎损伤的索赔。由三名麻醉医生和神经外科医生组成的三个独立团队，使用标准化的审查表格从索赔摘要中提取数据，并判断可能导致损伤的因素。
颈椎损伤索赔（n = 48；平均年龄 ± 标准差为 47 ± 15 岁；73%为男性）占所有全身麻醉索赔的比例不足 1%。与其他全身麻醉索赔（19%）相比，颈椎损伤索赔更常见为永久性和致残性（69%；P < 0.001）。此外，颈髓损伤（n = 37）比神经根和/或骨脊柱损伤（n = 10）更严重（P < 0.001），通常导致四肢瘫痪。尽管经常存在解剖学异常（如颈椎狭窄），但颈髓损伤通常发生在没有创伤性损伤（81%）或颈椎不稳定（76%）的情况下。颈髓损伤与颈椎（65%）和非颈椎（35%）手术有关。24%的颈髓损伤与坐姿有关。颈髓损伤的可能原因包括解剖学异常（81%）、直接手术并发症（24%[38%，颈椎手术]）、术前有症状的颈髓损伤（19%）、术中头/颈位置（19%）和气道管理（11%）。
大多数颈髓损伤发生在没有创伤性损伤、不稳定和气道困难的情况下。颈椎手术和/或坐姿手术似乎更为常见。在没有不稳定的情况下，颈椎骨关节炎是与颈髓损伤相关的最常见因素。
