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Perioperative Management and Surgical Challenges in Patients with Spinal Cord Dysfunction

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The High-risk Surgical Patient

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Abstract

People with spinal cord dysfunction due to spinal cord injury/disorder (SCI/D) represent a frail population with specific challenges, which are usually not reported in commonly adopted guidelines. If a surgeon does not take account of these needs, the risk for surgical complications is significantly high. The peculiarities of people with SCI/D should always be addressed when performing surgery in this population.

Autonomic dysreflexia is a potentially life-threatening complication consisting of headache, tachycardia, severe hypertension, tachypnea, convulsions, myocardial infarction, and hemorrhagic stroke. This condition could be triggered by pain, bladder/bowel distension, acute abdominal pathology, urinary tract infections (UTIs), and pressure ulcers. It is mandatory to adopt measures to reduce the risk for these stimuli.

Due to musculoskeletal problems (e.g., scoliosis, spasticity, sarcopenia, and pathological fractures), which are common in this population, people with SCI/D may present problems to take the position required for surgery. Surgeons should assess this ability pre-operatively.

Other common complications in people with SCI/D undergoing surgery include surgical-site infections, UTIs, pneumoniae, pressure ulcers, and thromboembolic events. The acknowledgment of these surgical complications is mandatory to prevent them by adopting the appropriate strategies to reduce their risks.

At last, surgery in people with SCI/D should be performed by top-level surgeons in multi-specialty hospitals with specific know-how about the needs of this population.

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Author information

Authors and Affiliations

  1. Neuro-Urology Service, Unipolar Spinal Unit, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Milan, Italy

    Gianluca Sampogna & Michele Spinelli

  2. Unit of Division of Oncologic and Mini-invasive General Surgery, ASST Grande Ospedale Metropolitano, Niguarda Hospital, Milan, Italy

    Antonello Forgione

  3. Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Giorgio Chevallard

Authors
  1. Gianluca Sampogna
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  2. Antonello Forgione
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  3. Giorgio Chevallard
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  4. Michele Spinelli
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Corresponding author

Correspondence to Gianluca Sampogna .

Editor information

Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

  2. Divisione di Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia, Pavia, Italy

    Antonino Massimiliano Grande

  3. Div. of Emerg. Surg., Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland

    Ari Leppäniemi

  4. Department of Pathophysiology and Transplantation, General Surgery and Trauma Team, University of Milano, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Osvaldo Chiara

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Sampogna, G., Forgione, A., Chevallard, G., Spinelli, M. (2023). Perioperative Management and Surgical Challenges in Patients with Spinal Cord Dysfunction. In: Aseni, P., Grande, A.M., Leppäniemi, A., Chiara, O. (eds) The High-risk Surgical Patient. Springer, Cham. https://doi.org/10.1007/978-3-031-17273-1_29

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