RESUMO
Background: Guidelines are needed to manage spinal cord infarctions. Here, we evaluated the incidence of noniatrogenic spinal ischemia, focusing on the spinal levels involved, and the relative efficacy of different management strategies. Methods: We performed a meta-analysis of 147 patients who sustained noniatrogenic spinal cord ischemia within the past 10 years. The most common causes of injury were idiopathic (i.e., 47% medical/surgery-related) followed by systemic/chronic conditions (23.6%) and aortic vascular pathology (20%). Postdiagnostic treatment options included rehabilitation in 53.7% of patients, while steroids (35.37%), antiplatelets aggregates (30.61%), and anticoagulation (18.37%) were also used. Results: Traumatic causes of spinal cord ischemia were associated with worse outcomes, while those without a clear diagnosis despite extensive work-up had better results. At discharge, patients managed with cerebrospinal fluid (CSF) drainage had significant improvement (P = 0.04), while other therapies were not effective. Notably, ischemia mostly occurring between the T4 and T7 levels and was associated with the worst outcomes. In this thoracic "watershed" region, thoracic cord ischemia was most likely attributed to an increased susceptibility toto cord under-perfusion in this region (P < 0.05). Conclusion: This meta-analysis revealed a variety of etiologies for noniatrogenic typically T4-T7 spinal cord ischemia. Several different treatment strategies may be utilized in this patient population, including CSF drainage, blood pressure elevation, corticosteroids, antiplatelets/anticoagulants/thrombolytics, mannitol, naloxone, surgical revascularization, hyperbaric oxygen, and systemic hypothermia.
RESUMO
BACKGROUND: We seek to characterize the features of iatrogenic spinal ischemia, determine which spinal levels are affected, and evaluate the efficacy of management strategies. METHODS: We performed a meta-analysis of case reports and series of spinal ischemia in the past 10 years. 343 full-length case reports and case series were screened against predefined inclusion/exclusion criteria. 89 patients were included for our final meta-analysis using PRISMA guidelines. RESULTS: Mean age of patients was 59.62 years (range: 9 months-88 years). 66% of all cases were male. Endovascular surgery (32.6%) and aortic surgery (36.0%) were most common causes of iatrogenic injury, followed by non-aortic surgery (32.6%), and non-surgical procedures (22.47%). 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 (40.45%). Non-aortic surgeries had the poorest overall outcomes (OR = 0.28, p = 0.016), whereas aortic and endovascular surgeries saw significant improvement in outcomes measured at discharge (OR = 2.6, OR = 2.3, respectively, p < 0.05). Therapeutic surgical infarctions were found to be associated with improved outcomes (OR = 5.33, p = 0.032). Ischemic injury to T4-T7, and T10 were associated with significantly poorer outcomes. Autonomic impairment was associated with a likelihood of infarction at T10 (OR = 4.54, p = 0.0183). CONCLUSIONS: 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.
