Stoelting's Anesthesia and Co-Existing Disease · 8th Edition
Disorders of the Spine and Spinal Cord
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ⓘ This audio and summary are simplified educational interpretations and are not a substitute for the original text.
Key Takeaways
- Spinal shock presents with flaccid paralysis and sensory loss below the injury level, distinct from neurogenic shock which causes autonomic dysregulation with hypotension and bradycardia.
- Autonomic hyperreflexia is a medical emergency affecting most patients with spinal lesions above T6, triggered by stimuli below injury level causing severe uncontrolled hypertension.
- Intraoperative neuromonitoring using somatosensory and motor evoked potentials requires specific anesthetic modifications including volatile agent restrictions and careful muscle relaxant selection.
- Cervical spinal injuries pose elevated respiratory risks from hypoventilation and impaired secretion clearance, requiring proactive airway and ventilatory management strategies.
- Congenital conditions like spina bifida necessitate latex-free protocols and individualized anesthetic planning based on associated neurologic and cardiopulmonary deficits present.
- Chronic spinal cord injury sequelae include respiratory compromise, spasticity, recurrent infections, renal dysfunction, osteoporosis, pressure ulcers, and thromboembolic complications requiring comprehensive management.
Chapter SummaryWhat this audio overview covers
Spinal disorders encompass a diverse range of acute injuries, chronic complications, and congenital or degenerative conditions that demand specialized anesthetic and perioperative management. The vertebral column contains 24 individual vertebrae organized into cervical, thoracic, and lumbar regions, with the spinal cord extending from the medulla oblongata through the lumbar spine and receiving blood supply from paired posterior arteries and a single anterior artery. Acute spinal cord injuries trigger spinal shock, characterized by flaccid paralysis and sensory loss distal to the lesion, which differs mechanically from neurogenic shock involving autonomic dysregulation with hypotension and bradycardia. The American Spinal Injury Association scale stratifies injury severity from complete to normal function, with cervical injuries posing particular respiratory risks due to hypoventilation and impaired secretion clearance. Chronic sequelae include respiratory compromise, spasticity, recurrent infections, and renal dysfunction, alongside complications from immobility such as osteoporosis, pressure ulcers, and thromboembolism. Autonomic hyperreflexia represents a life-threatening emergency occurring in the majority of patients with lesions above the sixth thoracic vertebra, wherein stimuli below the injury level provoke uncontrolled sympathetic discharge and severe hypertension blocked from central inhibition. Elective spine surgery for conditions like intervertebral disk disease, stenosis, spondylolisthesis, and scoliosis requires careful intraoperative neuromonitoring through somatosensory evoked potentials and motor evoked potentials, each with distinct anesthetic implications regarding volatile agents, muscle relaxants, and nitrous oxide. Congenital and degenerative diseases including spina bifida with associated latex sensitivity, tethered spinal cord syndrome, syringomyelia, amyotrophic lateral sclerosis, and Friedreich ataxia each present unique anesthetic challenges related to neurologic deficits, hyperkalemia risk with depolarizing agents, and cardiopulmonary complications requiring individualized management strategies.