Harvard Medical School, Boston, Massachusetts, USA.
Anesthesiology. 2011 Apr;114(4):918-26. doi: 10.1097/ALN.0b013e31820fc7f2.
Prompted by an increase in interventional pain treatments performed at the level of the cervical spine, we investigated the characteristics and patterns of injury in malpractice claims collected from January 1, 2005 to December 31, 2008.
We compared claims arising from cervical pain treatments with all other chronic pain claims collected from the American Society of Anesthesiologists' closed claims database between 2005 and 2008. Claims for spinal cord injury underwent in-depth analysis for mechanisms of injury and use of sedation during the procedure.
Claims related to cervical interventions represented 22% (64/294) of chronic pain treatment claims. Patients who underwent cervical procedures were healthier (American Society of Anesthesiologists' score, 1-2; P < 0.001) and were more often women (P = 0.011). Of the patients who underwent a cervical procedure, 59% experienced spinal cord damage compared with 11% of patients with other chronic pain (P < 0.001), with direct needle trauma as the predominant cause (31%). General anesthesia or sedation was used in 67% of cervical procedure claims associated with spinal cord injuries but in only 19% of cervical procedure claims not associated with spinal cord injuries (P < 0.001). Of the patients who underwent cervical procedures and had spinal cord injuries, 25% were nonresponsive during the procedure compared with 5% of the patients who underwent cervical procedures and did not have spinal cord injuries (P < 0.05, κ = 0.52).
Injuries related to cervical interventional pain treatment were often severe and related to direct needle trauma to the spinal cord. Traumatic spinal cord injury was more common in patients who received sedation or general anesthesia and in those who were unresponsive during the procedure. Further studies are crucial to define the usefulness of cervical interventions and to improve their safety.
随着颈椎介入性疼痛治疗的增加，我们调查了 2005 年 1 月 1 日至 2008 年 12 月 31 日期间从美国麻醉师协会（ASA）封闭索赔数据库中收集的医疗事故索赔中损伤的特征和模式。
我们比较了 2005 年至 2008 年期间与所有其他慢性疼痛索赔相关的颈椎疼痛治疗索赔。对脊髓损伤索赔进行了深入分析，以了解损伤机制和手术过程中镇静的使用情况。
与颈椎干预相关的索赔占慢性疼痛治疗索赔的 22%（64/294）。接受颈椎手术的患者更健康（ASA 评分 1-2；P<0.001），且更多为女性（P=0.011）。在接受颈椎手术的患者中，59%发生脊髓损伤，而其他慢性疼痛患者为 11%（P<0.001），主要原因是直接针损伤（31%）。在与脊髓损伤相关的颈椎手术索赔中，67%使用了全身麻醉或镇静，而在与脊髓损伤不相关的颈椎手术索赔中，这一比例仅为 19%（P<0.001）。在接受颈椎手术且发生脊髓损伤的患者中，25%在手术过程中无反应，而在接受颈椎手术且未发生脊髓损伤的患者中，这一比例为 5%（P<0.05，κ=0.52）。
与颈椎介入性疼痛治疗相关的损伤通常较为严重，与脊髓的直接针损伤有关。在接受镇静或全身麻醉的患者以及在手术过程中无反应的患者中，创伤性脊髓损伤更为常见。进一步的研究对于确定颈椎介入治疗的有效性和提高其安全性至关重要。
