title: Cervical spinal cord infarction after cervical spine decompressive surgery.
abstract: OBJECTIVE
  To report five patients who underwent cervical decompressive surgeries and developed persistent postoperative neurologic deficits compatible with spinal cord infarctions and evaluate causes for these rare complications.
  
  
  METHODS
  The clinical courses and imaging studies of five patients were retrospectively analyzed. Imaging findings, types of surgeries, vascular compromise or risk factors, hypotensive episodes, intraoperative somatosensory evoked potentials, concomitant brain infarctions, and clinical degree and radiographic extent of spinal cord infarction were studied. The presence of spinal cord infarction was determined by clinical course and imaging evaluation.
  
  
  RESULTS
  All five patients had antecedent cervical cord region vascular compromise or generalized vascular risk factors. Four patients developed hypotensive episodes, two intraoperatively and two postoperatively. None of the four patients with hypotensive episodes had imaging or clinical evidence of concomitant brain infarctions.
  
  
  CONCLUSIONS
  Neuroimaging evaluation of spinal cord infarction after decompressive surgery is done to exclude spinal cord compression, to ensure adequate surgical decompression, and to confirm infarction by imaging. Antecedent, unrecognized preoperative vascular compromise may be a significant contributor to spinal cord infarction by itself or in combination with hypotension.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kalb
authors.affiliation: Division of Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Saeed
authors.initials: S
authors.lastname: Fakhran
authors.affiliation: Division of Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Dean
authors.affiliation: Division of Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ross
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Randall W
authors.initials: RW
authors.lastname: Porter
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Udaya K
authors.initials: UK
authors.lastname: Kakarla
authors.affiliation: Department of Neuroradiology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Ruggieri
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@dignityhealth.org.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theodore
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications; D007238:Infarction / Q000209:etiology* / Q000473:pathology; D007796:Laminectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000601:surgery*; D020760:Spinal Cord Ischemia / Q000209:etiology* / Q000473:pathology; D013123:Spinal Fusion / Q000009:adverse effects; D014715:Vertebrobasilar Insufficiency / Q000150:complications