A new study looked back ten years to try to understand treatment choices and their related outcomes for iatrogenic spinal ischemia. What the study authors found is that this is one of those areas in spine care that is still largely a work in progress.
Treating Iatrogenic Spinal Ischemia Is a Work in Progress
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In “Iatrogenic spinal cord ischemia: A patient level meta-analysis of 74 case reports and series,” this study’s authors tried to define the features of iatrogenic spinal ischemia, determine which spinal levels are affected and evaluate the efficacy of management strategies.
The findings are published in the December 2021 issue of the North American Spine Society Journal.
To do this, they conducted a meta-analysis of case reports and series of spinal ischemia over the last 10 years. Eighty-nine patients were included in the final meta-analysis. The mean age of patients was 59.62 years (range: 9 months-88 years). The majority of the patients were male.
Endovascular surgery (32.6%) and aortic surgery (36.0%) were the most common causes of iatrogenic injury followed by non-aortic surgery (32.6%), and non-surgical procedures (22.47%).
In addition, A- and B-level ASIA Impairment was found in 66% of all patients. Rehabilitation was the most common management (49.44% of cases) followed by blood pressure management. Non-aortic surgeries had the poorest overall outcomes (OR = 0.28; p = 0.016). However, aortic and endovascular surgeries saw significant improvement in outcomes measured at discharge (OR = 2.6, OR = 2.3, respectively, p < 0.05).
While therapeutic surgical infarctions were associated with improved outcomes (OR = 5.33; p = 0.032), ischemic injury to T4-T7, and T10 were associated with poorer outcomes. Autonomic impairment was linked with a likelihood of infarction at T10 (OR = 4.54; p = 0.0183).
“In this paper, we compare outcomes following iatrogenic spinal ischemia. We demonstrate the need for more comprehensive randomized controlled trials to test effective treatment strategies,” the study authors wrote.
The researchers involved in the study included Anant Naik, Christina M. Moawad, Samantha L. Houser, T. Kesh Kesavadas and Paul M. Arnold of the University of Illinois.
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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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