In a retrospective review of 5,029 patients who underwent elective spine surgery, a team of researchers has helped move the needle on efforts to identify patients at risk for an ischemic stroke and reduce the risks that are inherent in a patient’s preoperative comorbidities.
How Common Is Ischemic Stroke During Spine Surgery?
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The researchers are from the Swedish Neuroscience Institute in Seattle, Washington, Heidelberg University Hospital in Germany, and the Sackler School of Medicine at Tel Aviv University in Israel.
Their study, “Intraoperative Ischemic Stroke in Elective Spine Surgery: A Retrospective Study of Incidence and Risk,” appears in the January 15, 2020 edition of Spine.
Co-author Basem Ishak, M.D., with the Department of Neurosurgery at Heidelberg University Hospital explained the objectives of the study to OTW, “We were looking for rare but catastrophic events in elective spine surgery. And complications which have not been described in detail in the literature before.”
The researchers looked specifically at the most severe complications including, as Dr. Ishak explained to OTW, “Hypertension, diabetes, smoking, dyslipidemia, and possibly major intraoperative CSF [cerebrospinal fluid].”
Ishak and his team documented a 29% in-hospital mortality rate for spine patients who’d experienced an intraoperative ischemic stroke. Among the 5,029 patients in the study, seven had developed an ischemic stroke during surgery and of those, six were female.
Dr. Ishak summarized the lessons from this study to OTW saying, “We expected that more patients with an intraoperative ischemic stroke would have had a high-grade carotid artery stenosis. The number of those patients was surprisingly low. The only patient with severe carotid stenosis had an ischemic pontine stroke which was likely unrelated to the preexisting carotid stenosis.”
“It is important to identify patients’ risk factors preoperatively and to optimize their comorbidities especially in elective spine surgery. Patients with intraoperative ischemic stroke carry a higher risk for morbidity and mortality during the index hospitalization.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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