scholarly journals Venous air embolus during prone cervical spine fusion: case report

2016 ◽  
Vol 25 (6) ◽  
pp. 681-684 ◽  
Author(s):  
Aurora S. Cruz ◽  
Marc Moisi ◽  
Jeni Page ◽  
R. Shane Tubbs ◽  
David Paulson ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Prone Position ◽  
Spine Surgery ◽  
Air Embolism ◽  
Intraoperative Complication ◽  
Cervical Spine Surgery ◽  
Venous Air Embolism ◽  
Dens Fracture ◽  
Air Embolus ◽  
Cervical Spine Fusion

Venous air embolism (VAE) is a known neurosurgical complication classically and most frequently occurring in patients undergoing posterior cranial fossa or cervical spine surgery in a sitting or semi-sitting position. The authors present a case of VAE that occurred during posterior cervical spine surgery in a patient in the prone position, a rare intraoperative complication. The patient was a 65-year-old man who was undergoing a C1–2 fusion for a nonunion of a Type II dens fracture and developed a VAE. While VAE in the prone position is uncommon, it is a neurosurgical complication that may have significant clinical implications both intraoperatively and postoperatively. The aim of this review is 2-fold: 1) to improve the general knowledge of this complication among surgeons and anesthesiologists who may not otherwise suspect air embolism in patients positioned prone for posterior cervical spine operations, and 2) to formulate preventive measures as well as a plan for prompt diagnosis and treatment should this complication occur.

scholarly journals POGOSTOST ZRAČNE EMBOLIJE IN POOPERATIVNI ZAPLETI PRI NEVROKIRURŠKIH POSEGIH V SEDEČEM POLOŽAJU Skrajšana verzija naslova: ZRAČNA EMBOLIJA PRI NEVROKIRURŠKIH POSEGIH V SEDEČEM POLOŽAJU

2015 ◽  
Vol 84 (9) ◽  
Author(s):  
Alenka Spindler Vesel ◽  
Nina Pirc ◽  
Božidar Visočnik ◽  
Jasmina Markovič - Božič
Keyword(s):  
Cervical Spine ◽  
Posterior Fossa ◽  
Spine Surgery ◽  
Air Embolism ◽  
Neck Surgery ◽  
Postoperative Treatment ◽  
Posterior Fossa Surgery ◽  
Cervical Spine Surgery ◽  
Venous Air Embolism ◽  
Doppler Probe

Background: Posterior fossa surgery and cervical spine surgery are at risk for venous air embolism (VAE) occurrence. Mostly air emboli are small and asymptomatic, but invasion of large quantity of air in the circulation is symptomatic and potentially lethal. Transesophageal echocardiography is the most sensitive method for detection of air emboli in the heart, followed by the precordial Doppler probe, end tidal carbon dioxide monitoring (etCO2) and others.Methods: In our 14- years retrospective review we evaluated the incidence of VAE and postoperative complications in patients with posterior fossa surgery or cervical spine surgery. VAE was recognized by using Doppler probe and/or drop of etCO2. If VAE occurred, aspiration of air through the CVC was used to prevent or to minimized VAE occurrence, the surgeon was warned about the incident. VAE treatment was supportive.Results: VAE was recognized in 74 patients. Two patients after head surgery and four patients after neck surgery needed postoperative treatment in intensive care unit and controled mechanical ventilation. In six patients after head surgery and in four patients after neck surgery new neurological symptoms occurred. Two patients after head surgery died due to complications of massive VAE.Conclusions: VAE is rare, but serious complication of neurosurgery in sitting position. Preventive treatment, early detection of VAE, supportive treatment and treatment of cardiovascular complications are necessary for survival of patients with VAE.

scholarly journals Prone Positioning of Patients with Cervical Spine Pathology

2019 ◽  
Vol 07 (02) ◽  
pp. 070-076
Author(s):  
Sarah L. Boyle ◽  
Zoe Unger ◽  
Vinay Kulkarni ◽  
Eric M. Massicotte ◽  
Lashmi Venkatraghavan
Keyword(s):  
Cervical Spine ◽  
Prone Position ◽  
Spine Surgery ◽  
Good Alternative ◽  
Neurological Injury ◽  
Prone Positioning ◽  
Cervical Spine Surgery ◽  
Advantages And Disadvantages ◽  
Flexion Extension ◽  
Spine Pathology

AbstractPatients with cervical trauma or degenerative disease often require surgical decompression and stabilization in the prone position and are at the risk of secondary neurological injury during this transfer. This review aims to explore the current literature on different methods of positioning patients prone and to identify the safest technique to achieve prone positioning in patients with an unstable cervical spine undergoing posterior cervical spine surgery. We searched the Embase, Medline, and Medline-in Process databases for literature in English related to prone positioning patients with cervical spine pathology undergoing spine surgery. Seventy-three citations were identified as relevant and reviewed in detail with 20 articles being identified as answering the clinical questions posed. Our literature review identified three methods of prone positioning patients with cervical pathology: logroll with manual in-line stabilization (MILS), rotating the patient on a specialized spinal table using a “sandwich and flip” technique, and awake prone positioning. Each of these methods has its own advantages and disadvantages. When comparing the degree of neck movement between positioning techniques, “sandwich and flip” rotation was associated with over 50% reduction in both flexion–extension and axial–lateral rotation as compared to logroll with MILS. Awake self-positioning of a patient is another alternative that allows for rapid neurological assessment after repositioning. A “sandwich and flip” is the safest way to turn a patient with cervical pathology into a prone position for surgery. For cooperative patients, who are physically capable, awake self-positioning is a good alternative.

The Effect of Position on PaCO2 and PETCO2 in Patients Undergoing Cervical Spine Surgery in Supine and Prone Position

2017 ◽  
Vol 29 (3) ◽  
pp. 298-303 ◽  
Author(s):  
Monu Yadav ◽  
Elmati Praveen Reddy ◽  
Ashima Sharma ◽  
Dilip Kumar Kulkarni ◽  
Ramachandran Gopinath
Keyword(s):  
Cervical Spine ◽  
Prone Position ◽  
Spine Surgery ◽  
Cervical Spine Surgery

scholarly journals Posterior Ischemic Optic Neuropathy after Cervical Spine Surgery

2021 ◽  
Vol 62 (10) ◽  
pp. 1449-1454
Author(s):  
Sung Do Cho ◽  
Dong Hyun Kim ◽  
Hee Kyung Yang ◽  
Jeong Min Hwang
Keyword(s):  
Visual Acuity ◽  
Cervical Spine ◽  
Prone Position ◽  
Spine Surgery ◽  
Steroid Therapy ◽  
Ischemic Optic Neuropathy ◽  
Epoetin Alfa ◽  
Cervical Spine Surgery ◽  
Posterior Ischemic Optic Neuropathy ◽  
Rbc Transfusion

Purpose: To describe a patient with posterior ischemic optic neuropathy (PION) after cervical spine surgery who recovered after treatment.Case summary: A 51-year-old woman presented with eye pain and decreased visual acuity in the left eye, which had begun 8 hours after cervical spine surgery in the prone position. Her best-corrected visual acuity (BCVA) was 20/20 in the right eye and hand motion in the left eye; a relative afferent pupillary defect was present in the left eye. Ductions and versions were normal with pain in the left eye. The results of slit lamp examination, fundoscopic examination, fluorescein angiography, and optical coherence tomography were unremarkable in both eyes. Brain and orbital magnetic resonance imaging showed no abnormal findings in the visual pathway, such as brain infarction or intracranial artery stenosis. The patient was diagnosed with PION in the left eye. Because postoperative anemia had developed with a rapid decrease in hemoglobin from 14.7 g/dL to 9.9 g/dL, red blood cell (RBC) transfusion was performed together with intravenous high-dose steroid therapy and subcutaneous epoetin alfa injection. After 3 weeks, the patient’s BCVA improved to 20/22 in the left eye.Conclusions: Unilateral PION developed after cervical spine surgery in the prone position. Visual improvement was observed after RBC transfusion, intravenous high-steroid therapy, and subcutaneous epoetin alfa injection.

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