The incidence of position-related neuropraxia in patients undergoing spine surgery


Winner of the Sanford J Larson Award, Gurpreet Surinder Gandhoke presented his research, Incidence of Position Related Neuropraxia in 4,489 Consecutive Patients Undergoing Spine Surgery. Role of SSEP Monitoring? during the 2016 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.

The authors reviewed records of 4,489 consecutive patients undergoing spine surgery at a university hospital. Within this group, there were reported incidence of peripheral nerve injury from positioning. IOM changes related to arm and leg positioning and their sensitivity and specificity predicting the development of a new position-related peripheral nerve injury was calculated. Impact of length of surgery and other variables, including age, sex, BMI, DM, HTN, CAD, CVD and a history of smoking, on the development of a new peripheral nerve injury were defined.

The positions were as follows: arms abducted and flexed at the elbow, 64.7%; arms tucked at the side, 35%; and the lateral position, 0.3%.

Thirteen out of 4,489 patients developed a new positioning-related peripheral nerve deficit. Fifty-four per cent developed meralgia paresthetica, and 46% developed ulnar neuropathy. Seventy-two (1.6%) patients developed IOM changes from positioning, and all of these patients underwent a repositioning manoeuvre. One of these 72 (1.3%) developed a new position-related nerve deficit. Of the 98.4% of patients who did not develop position-related IOM changes, 0.3% developed a new position-related nerve deficit.

Sensitivity of IOM to detect a new position-related nerve deficit was 7.69%, and the specificity was 98.41%. Neither the length of surgery or any analysed patient-related variable had a statistically significant impact on the development of a new neuropraxia.