Back Surgery And Stroke: Is There A Link?

Back surgery can lead to a stroke, although this is a rare occurrence. The risk of a stroke is higher with cardiac surgery than with non-vascular surgery. However, the risk of a stroke following back surgery is still between 0.1% and 1.9%. The type of back surgery can also influence the likelihood of a stroke, with spinal surgery having a higher risk than joint surgery.

Hemorrhagic strokes after back surgery are rare but can be fatal

The risk of a hemorrhagic stroke after back surgery is increased for patients with hypertension and coagulopathy. Additionally, low intracranial pressure (ICP) may also contribute to intracranial hemorrhages, especially subdural hemorrhages. Age and the experience level of the surgeon are also risk factors, and these risks are doubled if the patient has a history of disc surgery.

The clinical symptoms of a hemorrhagic stroke after back surgery typically include a headache, vomiting, consciousness disturbance, and mental disorders. The bleeding sites are usually located in the cerebellar hemisphere and temporal lobe, and they can occur several hours after surgery. Early diagnosis and treatment are crucial for preventing further progression of intracranial hemorrhages. However, the prognosis for patients who require hematoma evacuation is often poor.

The incidence of perioperative hemorrhagic stroke after spinal surgery has been reported to range from 0.07% to 1.0% in different studies, with an average incidence of 0.07% in a Chinese population. Hemorrhagic strokes account for approximately 40% of all stroke deaths, despite only making up about 15% of all strokes.

Risk factors for stroke after back surgery include age, sex, and history of stroke

While uncommon, it is possible to experience a stroke after back surgery. This is known as a perioperative stroke, which includes intraoperative strokes and postoperative strokes that occur within 30 days after surgery.

Risk factors for perioperative stroke include age, sex, and history of stroke.

Age is a significant factor, with the risk of perioperative stroke increasing six-fold for people aged 80 and above compared to younger patients. The risk of perioperative stroke also increases with the patient's age, with each decade of life associated with higher odds of perioperative stroke.

Being female is also a risk factor for perioperative stroke, with elderly female patients experiencing more rapid progression of atherosclerosis after menopause.

Additionally, patients with a history of stroke or transient ischemic attack have an elevated risk of perioperative stroke. This risk remains even after nine months, but expert opinion suggests that delaying elective non-neurological and non-cardiac surgery by at least one month after a stroke can help restore cerebral autoregulation and decrease the risk of perioperative stroke.

Atherosclerosis is a common cause of ischemic strokes

Atherosclerosis, often referred to as "hardening of the arteries", is a common cause of ischemic strokes. The word "atherosclerosis" comes from the Greek words "atheros", meaning gruel or paste, and "sclerosis", meaning hardness. It is a slow and complex disease that typically starts in childhood and progresses with age. While it can progress rapidly in some people in their 20s, for others, it does not become a threat until they reach their 50s or 60s.

Atherosclerosis is caused by the build-up of fatty substances, cholesterol, cellular waste products, calcium, and other materials in the inner lining of an artery, forming what is called plaque. This build-up thickens the artery wall, narrowing the blood vessel and reducing blood flow and the oxygen supply to the part of the body the artery serves. Over time, this can completely block blood flow, leading to an ischemic stroke.

Ischemic strokes occur when the arteries that bring blood to the brain or operate within the brain become narrowed or blocked. As a result, the brain does not get enough blood and oxygen, leading to stroke, also known as a cerebral vascular accident. Atherosclerosis can lead to two types of ischemic strokes: atherothrombotic stroke and embolic stroke.

Atherothrombotic stroke is the most common type of ischemic stroke caused by atherosclerosis. It occurs when plaque in a blood vessel breaks, leading to the formation of blood clots that can become large enough to reduce or block blood flow to the brain, resulting in a stroke.

Embolic stroke, on the other hand, occurs when a blood clot or other particle, called an embolus, breaks away from the rupture site and travels through the bloodstream. When it lodges in an artery leading to or in the brain, it blocks blood flow, resulting in a stroke. However, most embolic strokes are caused by blood clots that form due to atrial fibrillation and then enter the bloodstream.

Cerebral angiography can be used to identify the location of a stroke

While it is unclear whether or not one can have a stroke after back surgery, a cerebral angiogram can be used to identify the location of a stroke. Cerebral angiography is a diagnostic procedure that can reveal any issues with the blood vessels in your brain. It can be used to detect several issues, such as brain aneurysms, blood clots, and atherosclerosis. This test uses X-rays and a special dye called a contrast agent or contrast material.

During a cerebral angiography procedure, a small catheter is inserted into an artery in the groin or arm and guided up to the blood vessels in the brain. The contrast dye is then injected through the catheter, and X-ray images are taken to visualize the blood vessels and any abnormalities, such as aneurysms or arteriovenous malformations (AVMs). Cerebral angiography can also be used to diagnose blood clots, which are blockages in blood vessels that can cause a stroke.

Cerebral angiography is an effective diagnostic tool and is often used when other imaging techniques, such as CT or MRI scans, are unable to provide a clear diagnosis. The procedure is typically performed in a hospital or outpatient setting under local anesthesia, and the patient is usually able to return home the same day. However, it is important to note that cerebral angiography carries a small risk of complications, such as bleeding, infection, or stroke.

Cerebral angiography can provide much more detailed images of blood vessels than other imaging tests. It is a minimally invasive procedure that can help healthcare providers diagnose and evaluate blood vessel issues in the brain. By injecting a contrast dye into the bloodstream, the blood vessels can be seen more clearly on X-ray images. This allows doctors to identify any abnormalities or blockages that may be causing a stroke.

Treatments for hemorrhagic strokes include surgery to relieve intracranial pressure

A hemorrhagic stroke is a life-threatening medical emergency that occurs when a blood vessel in the brain breaks and bleeds. The bleeding disrupts the brain's normal circulation, preventing it from receiving the blood and oxygen it needs to function and survive. Additionally, the stroke increases intracranial pressure, which can damage or kill brain cells.

The two main treatments for hemorrhagic strokes are medications and surgery. Medications are used to support clotting and manage blood pressure, while surgery may be required to remove the blood and relieve intracranial pressure.

Medications for Hemorrhagic Strokes

Clotting Support Medications:

• Vitamin K therapy
• Prothrombin complex concentrate

These medications enhance the body's natural clotting process to stop the bleeding in the brain.

Blood Pressure Management Medications:

Intravenous (IV) blood pressure medication

These medications help to slow the brain bleed and promote safe clotting by keeping blood pressure within a safe range.

Surgery for Hemorrhagic Strokes

Surgery may be necessary if the stroke has caused a large area of bleeding that is increasing intracranial pressure. The goal of surgery is to remove the accumulated blood and relieve the pressure on the brain tissue. Here are some specific surgical procedures that may be used:

• Craniotomy: Surgery performed through the skull to access and remove the blood, thereby reducing pressure on the brain.
• Surgical Clipping: Placement of a tiny clamp at the base of an aneurysm to stop blood flow and prevent bursting or re-bleeding.
• Surgical AVM Removal: Removal of a small arteriovenous malformation (AVM) in an accessible area of the brain to eliminate the risk of rupture and reduce the likelihood of hemorrhagic stroke. However, this may not be possible if the AVM is located deep in the brain, is too large, or its removal would significantly impact brain function.
• Angioplasty and Stents: A catheter is threaded through an artery in the groin to the carotid arteries. A balloon is inflated to expand the narrowed artery, and a stent is inserted to keep it open.

Rehabilitation After Hemorrhagic Stroke

In addition to medical and surgical treatments, stroke rehabilitation is crucial for helping individuals adjust to changes in their brain and body. This may include speech therapy, physical therapy, and occupational therapy to regain or improve language skills, muscle strength, balance, and the ability to perform daily tasks. Cognitive therapy may also be beneficial for improving memory, concentration, and other mental abilities.

Frequently asked questions