Spinal and Epidural Anesthesia in Patients With Recent Stable Fractures of Vertebral Column

Background: The use of central neuraxial block (CNB) in patients with spinal injuries with or without spinal cord injury continues to be a contentious issue due to paucity of evidence supporting or refuting its use. There are only a few case reports reporting the use of the technique in these patients. We performed a retrospective record review of patients who underwent neuraxial blockade for lower limb orthopedic surgery in the presence of coexisting recent spine injury (defined as spine injury within 1 month) to assess the occurrence of postoperative deterioration of spinal cord function or occurrence of new spinal cord dysfunction. Materials and Methods: The hospital records of patients with recent stable traumatic fractures of the vertebral column who underwent lower limb orthopedic surgery under CNB from January 2010 to December 2013 were reviewed. Data collected included age, sex, level of fracture, number of vertebrae injured, presence of neurological deficits, interval between injury and surgery, number of surgeries, level of CNB, number of vertebral segments between the site of injury and CNB, position of patient used for CNB and surgery, and perioperative adverse hemodynamic events. All patients underwent detailed postoperative neurological examination and any deterioration or occurrence of new spinal cord dysfunction was noted. Results: Nineteen patients underwent 21 CNBs for lower limb orthopedic procedures. There were 12 men and 7 women. Thoracolumbar area (18/19) was the commonest site of fractures. Two patients had neurological deficits due to cervical spine trauma. More than 50% of the patients had multiple bone fractures and nearly 30% had associated nonorthopedic trauma. Six patients underwent surgery within the first week (4 to 7 d) after trauma. In 80% of the patients, there was a gap of atleast 2 vertebrae between the level of injury and CNB administration. There were no perioperative adverse hemodynamic events requiring prolonged inotropic support. None of the patients had neurological deterioration or new changes. Conclusions: Spinal and epidural anesthesia in patients with recent stable fractures of the spine was not associated with adverse neurological events. The findings of this study may be particularly relevant to patients with recent stable vertebral fractures who require surgery but present with conditions that place them at high risk for general anesthesia.

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