The use of modest systemic hypothermia after iatrogenic spinal cord injury during surgery

Iatrogenic spinal cord injury (SCI) is an uncommon (0%-3%), yet devastating, complication of spine surgery. Recent evidence based on small clinical studies indicates that modest hypothermia is a feasible treatment option for severe SCI. We extended this treatment modality to patients with devastating iatrogenic SCI. We conducted a retrospective case series of five male patients (cervical trauma--1, cervical degenerative--2, thoracic trauma--1, and thoracic scoliosis--1) with an age range of 16-51 years (average age of 46 years) with intraoperative motor-evoked potential/somatosensory-evoked potential loss secondary to catastrophic events during the spinal operation associated with new SCI. Modest hypothermia was instituted immediately postsurgery for 24 hours. Four patients also received methylprednisolone. Preoperative American Spinal Injury Association (ASIA) scores were D (n=3) and E (n=2), while immediate postoperative scores were A (n=1), B (n=1), C (n=2), and D (n=1). Immediate postoperative MRI revealed new cord signal change in three patients. Two patients required subsequent surgery. ASIA scores at last follow-up were C (n=1), D (n=3), and E (n=1) with an improvement of 1-2 grades per patient. Adverse events such as pulmonary embolism, deep venous thrombosis, coagulopathy, or infection were not observed. Hypothermia is a feasible treatment option for patients with iatrogenic SCI. While hypothermia has not been proven to improve outcomes in these situations, aggressive medical management, including cooling, resulted in better-than-expected outcomes in this small cohort.