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%). Conclusion: 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.
Bibliographical noteFunding Information:
Received from the Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, and the Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington. Submitted for publication August 30, 2010. Accepted for publication December 28, 2010. Supported in part by the American Society of Anesthesiologists (Park Ridge, Illinois) and the Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City. Dr. Traynelis has received research and educational grants from Medtronic, Inc. (Minneapolis, Minnesota), Globus Medical, Inc. (Audubon, Pennsylvania), and the Neurosurgery Research and Education Foundation of the American Association of Neurological Surgeons (Rolling Meadows, Illinois) for management of cervical spine disease. He is also a paid consultant for United HealthCare Services, Inc. (Minneapolis, Minnesota) and Medtronic, Inc. In addition, Dr. Traynelis holds the following patents from which he has received patent and/or licensing royalties: U.S. patent 7 727 266, Method and apparatus for retaining screws in a plate; U.S. patent 7 276 082, Artificial spinal discs and associated implantation and revision methods; U.S. patent 7 300 441, Technique and instrumentation for preparation of vertebral members. Dr. Sawin is a paid consultant for NuVasive, Inc. (San Diego, California). Dr. Tredway has received honoraria from Synthes, Inc. (West Chester, Pennsylvania) and Medtronic, Inc., for lecturing on related topics. The remaining authors are not supported by, nor maintain any financial interest in, any commercial activity that may be associated with the topic of this article. Presented in part at the annual Midwest Anesthesia Residents Conference, Saint Louis, Missouri, April 14, 2007, and at the annual meeting of the American Society of Anesthesiologists, San Diego, California, October 18, 2010.