INTRODUCTION Stroke during hospitalization for spinal disease is relatively rare, with an incidence of 0.05–0.22%. However, stroke can result in prolonged hospitalization, persistent neurological damage, and even death. To help prevent stroke and respond early to its onset, it is necessary to identify the predictors of stroke in patients with spinal diseases. Therefore, this study aimed to identify these risk factors.
METHODS A case series study was conducted on consecutive patients aged 18 or above who were admitted for the treatment of spine diseases at our university hospital between April 2011 and March 2023. Of the 2,391 patients initially identified, 45 who underwent debridement for surgical site infections were excluded. Ultimately, 2,346 patients were included in the analysis. Because only a few patients in our study cohort experienced stroke (n=3), a comprehensive statistical analysis was not feasible. To address this issue, a meta-analysis including the present case series was performed. Our literature search encompassed databases such as PubMed and Google Scholar, and focused on original peer-reviewed articles written in English pertaining to this subject. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.
RESULTS Of the 2,346 patients, only the following three (0.13%) experienced strokes: (1) A 43-year-old male patient with a medical history of cerebral contusion experienced cerebral hemorrhage resulting from dural injury during posterior occipito-cervical fusion. He became stuporous during surgery and required emergency treatment, but ultimately achieved full recovery. (2) A 65-year-old male patient with a medical history of hypertension, aortic regurgitation, myocardial infarction, and left ventricular aneurysm experienced cerebral infarctions following lumbar laminectomy due to anticoagulant discontinuation. At 11 days postoperatively, he developed hemiplegia and dysarthria, leading to permanent partial paralysis in the right lower limb despite anticoagulation and antithrombotic therapy. (3) An 85-year-old male patient with a medical history of cerebral infarction experienced cerebral infarctions following anterior thoracic fusion due to anticoagulant discontinuation. At 8 hours postoperatively, the patient experienced a cardiopulmonary arrest. Despite anticoagulation and antithrombotic therapy, he remained severely disabled and died of pneumonia three months later. The subsequent meta-analysis included four studies involving 197,869 patients admitted for treatment of spinal diseases. Evidence indicated that strokes during hospitalization were related to older age (OR 3.23; 95%CI 2.48–4.22; p<0.001), cervical level (OR 1.33; 95%CI 1.06–1.07; p=0.010), thoracic level (OR 3.14; 95%CI 1.01–9.75; p=0.049), hypertension (OR=2.27; 95%CI 1.84–2.80; p<0.001), history of heart disease (OR 2.45; 95%CI 1.92–3.13; p<0.001), diabetes (OR 2.06; 95%CI 1.70–2.51; p<0.001), and hemodialysis (OR 3.37; 95%CI 1.23–9.23; p=0.020).
DISCUSSION The incidence of stroke in this study (0.13%) was similar to that reported (0.05–0.22%) in previous studies. The present case series describes various potential risk factors including age, medical history, and surgical level. The subsequent meta-analysis reinforced the impact of these predictors on stroke risk during hospitalization for spinal diseases. Careful monitoring of impaired consciousness and neurological symptoms after hospitalization for spinal diseases with these predictors is essential.