Our Summary

The paper discusses a condition called cervical spondylotic myelopathy (CSM), which can make people more likely to suffer from spinal cord injuries and paralysis of all four limbs during non-spine surgeries. This is not well documented, with only 18 cases, including the authors’, reported so far. The causes of this are complex, and simply maintaining a neutral position of the cervical cord during surgery doesn’t guarantee that the patient won’t suffer a cord injury. Other factors, like the patient’s mean arterial pressure (a measure of blood flow), are also crucial. The paper also suggests the need for more research into how a patient is positioned during surgery, particularly with respect to the Trendelenburg position which is often used in robotic surgeries, and whether this contributes to congestion and lack of blood supply to the spinal cord in patients with CSM. The authors stress on the need for doctors to be more aware of CSM, especially in older patients, as it’s often an overlooked health issue.

FAQs

  1. What is cervical spondylotic myelopathy (CSM) and how does it impact spinal surgeries?
  2. What are the factors that can lead to spinal cord injuries during non-spine surgeries for patients with CSM?
  3. How could a patient’s positioning during surgery, especially in the Trendelenburg position, potentially affect the blood supply to the spinal cord in patients with CSM?

Doctor’s Tip

One helpful tip a doctor might tell a patient about spinal surgery is to follow post-operative instructions carefully, including proper positioning, gentle movement, and physical therapy exercises to aid in recovery and prevent complications. It is important to communicate any concerns or changes in symptoms to your healthcare provider promptly.

Suitable For

Patients who are typically recommended spinal surgery include those with conditions such as cervical spondylotic myelopathy (CSM), spinal stenosis, herniated discs, degenerative disc disease, spinal fractures, spinal tumors, and spinal deformities such as scoliosis. These patients may experience symptoms such as severe neck or back pain, weakness or numbness in the arms or legs, difficulty walking, loss of bladder or bowel control, and spinal cord compression. Additionally, patients who have not responded to conservative treatments such as physical therapy, medication, and injections may also be recommended for spinal surgery.

Timeline

Before spinal surgery:

  1. Patient experiences symptoms such as neck or back pain, numbness, weakness, or difficulty walking.
  2. Patient undergoes diagnostic tests such as MRI or CT scans to determine the cause of their symptoms.
  3. Patient consults with a spine surgeon to discuss treatment options, including spinal surgery.
  4. Patient undergoes pre-operative testing and preparation for surgery.

After spinal surgery:

  1. Patient undergoes spinal surgery to address the underlying spinal condition.
  2. Patient is monitored closely in the post-operative period for any complications or signs of improvement.
  3. Patient may require physical therapy or rehabilitation to regain strength and mobility.
  4. Patient follows up with their surgeon for post-operative care and monitoring of their recovery progress.
  5. Patient experiences improvement in their symptoms and quality of life following successful spinal surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with spinal surgery for my specific condition?
  2. How experienced are you in performing this type of spinal surgery?
  3. What is the expected outcome of the surgery in terms of pain relief and functional improvement?
  4. What is the recovery process like after spinal surgery and how long will it take?
  5. Are there any alternative treatments or less invasive options available for my condition?
  6. Will I need physical therapy or rehabilitation after the surgery?
  7. What are the long-term effects of the surgery on my spinal health?
  8. How will my condition be monitored and managed post-surgery?
  9. Are there any specific precautions I should take to prevent complications during and after the surgery?
  10. What can I do to ensure the best possible outcome from the surgery?

Reference

Authors: Mathkour M, McCormack E, Hanna J, Werner C, Skinner K, Borchardt JA, Dumont AS, Maulucci CM. Journal: Clin Neurol Neurosurg. 2019 Dec;187:105549. doi: 10.1016/j.clineuro.2019.105549. Epub 2019 Nov 2. PMID: 31707289