Morimoto Tadatsugu, Kobayashi Takaomi, Hirata Hirohito, Tsukamoto Masatsugu, Yoshihara Tomohito, Toda Yu, Ito Hayato, Otani Koji, Mawatari Masaaki
Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan.
Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, Japan.
Spine Surg Relat Res. 2023 Dec 27;8(2):171-179. doi: 10.22603/ssrr.2023-0213. eCollection 2024 Mar 27.
Perioperative cerebrovascular accidents (CVAs) related to spine surgery, although rare, can lead to significant disabilities. More studies on spine surgeries are required to identify those at risk of perioperative CVAs. The characteristics and outcomes of patients that experienced CVAs during spine surgery were assessed through a retrospective descriptive study and meta-analysis.
Patients aged ≥18 years who underwent spine surgery under general anesthesia at a hospital between April 2011 and March 2023 were examined. Of the 2,391 initially identified patients, 2,346 were included after excluding 45 who underwent debridement for surgical site infections. Subsequently, a meta-analysis including the present retrospective descriptive study was conducted. Databases such as PubMed and Google Scholar were searched for original peer-reviewed articles written in English.
Of the 2,346 patients, 4 (0.17%) (three men, one woman) exhibited perioperative CVAs associated with spine surgery. The CVAs were diverse in nature: one case of cerebral hemorrhage resulting from dural injury during posterior occipitocervical fusion, two cases of cerebral infarctions after lumbar laminectomy and anterior thoracic fusion due to anticoagulant discontinuation, and one case of posterior reversible encephalopathy syndrome following microscopic lumbar discectomy due to gestational hypertension. The subsequent meta-analysis included three studies (n=186,860). It showed several risk factors for perioperative CVAs, including cervical level (pooled odds ratio [OR]=1.33), hypertension (pooled OR=2.27), atrial fibrillation (pooled OR=8.78), history of heart disease (pooled OR=2.47), and diabetes (pooled OR=2.13).
It was speculated that the potential risk factors for the four perioperative CVA cases of spine surgery in this retrospective descriptive study were intraoperative dural injury, preoperative anticoagulant discontinuation, and gestational hypertension history. The meta-analysis revealed that cervical spine surgery, hypertension, atrial fibrillation, heart disease, and diabetes increased the CVA risk. This highlights the need for risk assessment, preoperative optimization, and postoperative care to reduce spine surgery-associated perioperative CVAs.
与脊柱手术相关的围手术期脑血管意外（CVA）虽罕见，但可导致严重残疾。需要更多关于脊柱手术的研究来确定围手术期发生CVA的风险人群。通过一项回顾性描述性研究和荟萃分析，评估了在脊柱手术期间发生CVA的患者的特征和结局。
对2011年4月至2023年3月期间在一家医院接受全身麻醉下脊柱手术的18岁及以上患者进行检查。在最初确定的2391例患者中，排除45例因手术部位感染而接受清创术的患者后，纳入2346例患者。随后，进行了一项包括本回顾性描述性研究的荟萃分析。在PubMed和谷歌学术等数据库中搜索以英文撰写的经同行评审的原始文章。
在2346例患者中，4例（0.17%）（3名男性，1名女性）出现了与脊柱手术相关的围手术期CVA。这些CVA性质多样：1例为后枕颈融合术中硬脑膜损伤导致的脑出血，2例为腰椎椎板切除术后和前路胸椎融合术后因停用抗凝剂导致的脑梗死，1例为因妊娠高血压在显微镜下腰椎间盘切除术后发生的后部可逆性脑病综合征。随后的荟萃分析纳入了三项研究（n=186,860）。结果显示了围手术期CVA的几个危险因素，包括颈椎节段（合并比值比[OR]=1.33）、高血压（合并OR=2.27）、心房颤动（合并OR=8.78）、心脏病史（合并OR=2.47）和糖尿病（合并OR=2.13）。
据推测，在这项回顾性描述性研究中，脊柱手术的4例围手术期CVA病例的潜在危险因素为术中硬脑膜损伤、术前停用抗凝剂和妊娠高血压病史。荟萃分析显示，颈椎手术、高血压、心房颤动、心脏病和糖尿病会增加CVA风险。这突出了进行风险评估以及术前优化和术后护理以减少与脊柱手术相关的围手术期CVA的必要性。
