Kopp Sandra L, Peters Shannon M, Rose Peter S, Hebl James R, Horlocker Terese T
From the *Department of Anesthesiology, and †Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN.
Reg Anesth Pain Med. 2015 Sep-Oct;40(5):502-5. doi: 10.1097/AAP.0000000000000203.
Spinal stenosis has been proposed as a previously unrecognized risk factor for neurologic complications after neuraxial techniques.
We report progression of neurologic symptoms after spinal anesthesia in 2 patients with preexisting spinal stenosis, characterized preoperatively solely by nonradicular back pain. One patient had complete resolution of his proximal lower-extremity weakness/numbness within 48 hours. In the second patient, the pain became severe and disabling, requiring surgical decompression.
We conclude that, until the relative contribution of patient and surgical (eg, positioning, retractors, hypotension) factors is known, the decision to perform neuraxial blockade in patients with severe symptoms of neuroclaudication or recently progressive symptomatic spinal stenosis should be made cautiously. Avoidance of spinal anesthesia is suggested for any procedure with prolonged lordotic positioning or any position that might cause a compromise of the spinal canal because subarachnoid block may contribute to any deterioration suffered by the patient.
