title: Cervical spinal cord, root, and bony spine injuries: a closed claims analysis.
abstract: BACKGROUND
  The aim of this study was to characterize cervical cord, root, and bony spine claims in the American Society of Anesthesiologists Closed Claims database to formulate hypotheses regarding mechanisms of injury.
  
  
  METHODS
  All general anesthesia claims (1970-2007) in the Closed Claims database were searched to identify cervical injuries. Three independent teams, each consisting of an anesthesiologist and neurosurgeon, used a standardized review form to extract data from claim summaries and judge probable contributors to injury.
  
  
  RESULTS
  Cervical injury claims (n = 48; mean ± SD age 47 ± 15 yr; 73% male) comprised less than 1% of all general anesthesia claims. When compared with other general anesthesia claims (19%), cervical injury claims were more often permanent and disabling (69%; P < 0.001). In addition, cord injuries (n = 37) were more severe than root and/or bony spine injuries (n = 10; P < 0.001), typically resulting in quadriplegia. Although anatomic abnormalities (e.g., cervical stenosis) were often present, cord injuries usually occurred in the absence of traumatic injury (81%) or cervical spine instability (76%). Cord injury occurred with cervical spine (65%) and noncervical spine (35%) procedures. Twenty-four percent of cord injuries were associated with the sitting position. Probable contributors to cord injury included anatomic abnormalities (81%), direct surgical complications (24% [38%, cervical spine procedures]), preprocedural symptomatic cord injury (19%), intraoperative head/neck position (19%), and airway management (11%).
  
  
  CONCLUSIONS
  Most cervical cord injuries occurred in the absence of traumatic injury, instability, and airway difficulties. Cervical spine procedures and/or sitting procedures appear to predominate. In the absence of instability, cervical spondylosis was the most common factor associated with cord injury.
authors.affiliation: Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Hindman
authors.forename: John P
authors.initials: JP
authors.lastname: Palecek
authors.forename: Karen L
authors.initials: KL
authors.lastname: Posner
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Traynelis
authors.forename: Lorri A
authors.initials: LA
authors.lastname: Lee
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sawin
authors.forename: Trent L
authors.initials: TL
authors.lastname: Tredway
authors.forename: Michael M
authors.initials: MM
authors.lastname: Todd
authors.forename: Karen B
authors.initials: KB
authors.lastname: Domino
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects*; D000776:Anesthesiology; D002574:Cervical Vertebrae / Q000293:injuries / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011187:Posture; D012955:Societies, Medical; D013119:Spinal Cord Injuries / Q000209:etiology*; D013124:Spinal Injuries / Q000209:etiology*; D013126:Spinal Nerve Roots / Q000293:injuries*; D055009:Spondylosis / Q000150:complications; D014481:United States