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Cardiac risk stratification of patients with symptomatic spinal stenosis

T Faciszewski1, R Jensen, R Rokey

  • 1Marshfield Clinic, WI 54449, USA.

Clinical Orthopaedics and Related Research
|March 16, 2001
PubMed

Insights

Many older adults undergoing lumbar surgery have silent heart disease. Cardiac stress testing revealed 8% had ischemia, recommending screening for those with heart disease or smoking history.

Area of Science:

  • Cardiology
  • Neurosurgery
  • Geriatric Medicine

Background:

  • Cardiac events are a leading cause of perioperative death after noncardiac surgery.
  • The increasing number of lumbar surgeries in patients over 65 necessitates understanding their cardiac risks.
  • Neurogenic claudication patients over 65 often have co-existing cardiac risk factors.

Purpose of the Study:

  • To determine the prevalence of silent ischemic heart disease in patients with neurogenic claudication undergoing elective lumbar surgery.
  • To identify risk factors associated with cardiac ischemia in this patient population.

Main Methods:

  • Cardiac chemical stress testing was employed to assess myocardial ischemia.
  • 140 patients with neurogenic claudication considered for elective lumbar surgery were included.

Main Results:

  • 8% (11 of 140) of patients demonstrated induced cardiac wall abnormalities, indicative of myocardial ischemia.
  • Smoking and a history of heart disease were the only identified risk factors for cardiac ischemia.

Conclusions:

  • Dobutamine stress echocardiography is recommended for patients undergoing elective spinal surgery for symptomatic spinal stenosis.
  • Screening should be prioritized for patients with a history of heart disease and/or smoking.

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