Perioperative Ischemic and Hemorrhagic Stroke in Spine Surgery: A Series of 5 Cases.

BACKGROUND: Stroke is a potentially life-threatening condition that can lead to disability and prolonged hospital stay. Perioperative stroke is a rare complication of spine surgery, especially in elective procedures. The prevalence of this complication varies in the literature, and the physiopathology is uncertain in many cases. Our objective was to describe 5 cases of patients who underwent spine surgery complicated by perioperative stroke and to analyze their characteristics and clinical outcomes. METHODS: We retrospectively analyzed data from spine surgeries performed at a single institution from January 2016 to December 2019. Patients who presented with perioperative stroke were included. Data related to patient demographics, postoperative status, hospital stay, type of surgery, American Society of Anesthesiologists (ASA) score, neurologic status at discharge, and mortality were registered. RESULTS: Five of 1002 consecutive patients (0.49%) had complication of stroke during surgery. The surgeries included occipitocervical fusion, anterior cervical fusion, lumbar fusion, lumbosacral fusion, and thoracolumbar fusion. The mean age of patients was 52.2 ± 15.73 years (range, 39-78 years), and the mean time of hospitalization was 20 ± 26.93 days (range, 6-68 days). The majority of patients were women (80%). Three patients (60%) presented with ischemic stroke, and 2 patients (40%) had hemorrhagic stroke. Two patients were severely disabled, and 3 showed good neurologic outcomes; no in-hospital deaths were observed. The etiology of stroke remained uncertain in the majority of cases. CONCLUSIONS: Despite the rarity of this complication, perioperative stroke in spine surgery can lead to considerable morbidity. Precocious diagnosis and treatment may improve patient outcomes.

The Results of Microsurgery without Fusion for Lumbar Synovial Cysts: A Case Series of 50 Patients.

OBJECTIVES: The treatments described for spinal synovial cysts range from percutaneous puncture to arthrodesis. There is a fear of postoperative instability after surgical resection of cysts, mainly when they are associated with degenerative spondylolisthesis. The objective of the article is to address the postoperative instability and recurrence rate of the symptoms after microsurgery without fusion. METHODS: We report a consecutive series of 50 patients with lumbar synovial cysts operated on with microsurgery without arthrodesis. Functional status was assessed postoperatively by the MacNab success scale and by self-assessment using the Weiner scale, the 36-item short-form health survey (SF-36), and the Oswestry scale. The presence of preoperative and postoperative instability was determined with static and dynamic lumbar spine X-rays before surgery and in the last follow-up at 2 years to evaluate the presence of spondylolisthesis before and after surgery. Facet inclination angle and stage of disc degeneration at the level of the cysts were evaluated. Disc degeneration was defined by the modified Pfirrmann grading system. RESULTS: The mean Oswestry index was 12 ± 12.6% (median 8, 0-53). Based on the MacNab scale, 98% were considered excellent and good. The Weiner scale showed that low back pain was present in 16% of patients postoperatively. There was significant improvement of leg strength and pain in 96% and 94%, respectively. Only 3 patients were reoperated on with late fusion. Total surgical resection was obtained in all cases, with a late fusion rate of only 6% and no recurrence at the operated site. CONCLUSIONS: The microsurgical treatment for synovial cysts without arthrodesis presented excellent and good results in the majority of cases. It is necessary to carry out prospective randomized studies to clarify the best therapeutic options.