Diaz Anthony, Chin Christopher, Burks Stephen S, McCarthy David, Matadial Christina, Levene Howard B
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA.
Cureus. 2021 Jan 7;13(1):e12550. doi: 10.7759/cureus.12550.
The preoperative medical clearance process is well established to screen for medical comorbidities and therefore must be thorough. However, screening for potential cervical spine disease is often overlooked. In older surgical candidates, the presence of cervical spondylosis can increase risk of iatrogenic cervical spine injury during prolonged neck extension in non-spinal surgeries. We present a standard protocol for cervical spine clearance and a novel sustained neck extension maneuver through a retrospective case series.
Sixty-three consecutive cases that underwent preoperative cervical clearance between April 2012 and December 2019 were reviewed. Referral for clearance occurred through the department of anesthesiology after concerning radiographic or physical exam findings were noted. A standard preoperative screening protocol with a sustained one-minute neck extension maneuver was implemented. Recommendations were made for standard neck precautions with or without neuromonitoring or for cervical spine decompression surgery prior to the planned procedure.
There were 25 patients with symptoms of myelopathy, 11 with radiculopathy and 13 with neck pain at baseline. Cervical spondylosis was observed in 51 patients, cervical canal stenosis in 29 and cervical myelomalacia in six. Fifty-seven patients underwent neck extension exam and 25 exhibited new or worsening symptoms. Myelopathic symptoms and radicular pain at baseline and positive Hoffman's and Spurling's sign, independently, were significantly associated with a positive neck extension exam (p<0.05). Fourteen patients were recommended for cervical decompression prior to planned procedure.
Our preoperative cervical spine clearance protocol is safe and may aid in identifying patients susceptible to iatrogenic cervical spine injury.
术前医学评估流程已成熟确立，用于筛查合并症，因此必须全面。然而，潜在颈椎疾病的筛查常常被忽视。在老年手术患者中，颈椎病的存在会增加非脊柱手术中长时间颈部伸展时医源性颈椎损伤的风险。我们通过一项回顾性病例系列研究，提出了一种颈椎评估的标准方案以及一种新的持续性颈部伸展手法。
回顾了2012年4月至2019年12月期间连续进行术前颈椎评估的63例病例。在影像学检查或体格检查发现异常后，由麻醉科转诊进行评估。实施了一项标准的术前筛查方案，包括持续一分钟的颈部伸展手法。针对计划手术前的标准颈部预防措施提出了建议，这些措施包括使用或不使用神经监测，或进行颈椎减压手术。
基线时，有25例患者出现脊髓病症状，11例出现神经根病症状，13例出现颈部疼痛。51例患者观察到颈椎病，29例出现颈椎管狭窄，6例出现颈椎脊髓软化。57例患者接受了颈部伸展检查，其中25例出现了新的或加重的症状。基线时的脊髓病症状和神经根性疼痛，以及阳性的霍夫曼征和斯普林试验征，均与颈部伸展检查阳性显著相关（p<0.05）。14例患者被建议在计划手术前进行颈椎减压。
我们的术前颈椎评估方案是安全的，可能有助于识别易发生医源性颈椎损伤的患者。
