Evaluation of aetiological factors in adverse outcome for neurosurgical intervention in patients of solitary spinal plasmacytoma with neurological deficits.

Col (Dr) Sanjay Kumar; Col (Dr) Subir Dey

Volume : X, Issue : I, January - 2020

Evaluation of aetiological factors in adverse outcome for neurosurgical intervention in patients of solitary spinal plasmacytoma with neurological deficits.

Col Dr Sanjay Kumar, Col Dr Subir Dey

Abstract :

Aims & Objective: Complications are known to occur in neurosurgical practice. But there are some complications which are beyond our understanding and do occur in patients postoperatively. Our aim was to analyse the cause and propose a theory for the rapidly fatal outcome in three patients of solitary spinal plasmacytoma with neurological deficits who underwent decompression along with instrumentation for stabilisation of the spine. Material and Methods: Retrospective analysis of patients who were diagnosed as a case of solitary spinal plasmacytoma presenting with neurological deficits from a cohort of all patients with presenting with verteal fractures managed at our centre During the period of aug 2014 to dec 2016 were included in the study. There were a total of 11 patients of solitary spinal plasmacytoma who underwent surgical intervention and 3 patients from this group of patients had a fatal outcome and expired within a period of 12 hours after the surgery. The preoperative haematological and biochemical parameters, renal function status, perioperative events with special emphasis on the episodes of hypotension, total intra–operative blood loss volume and volume of blood/blood products transfused in these 3 patients were analysed to elucidate the cause of adverse outcome in these subgroup of patients. Results: The three patients of solitary spinal plasmacytoma who had adverse outcome were detected to have at least one episode of intra–operative hypotension, higher blood loss volume (>1000 ml) and large volume intra–operative transfusion of blood/blood products (>1000 ml). These three factors were which were not present in 8 of the other patients of solitary spinal plasmacytoma and hence were thought to be predictors of the adverse outcome in the 3 patients with similar preoperative profile in all the 11 patients. Conclusions: This study revealed that in patients of solitary spinal plasmacytoma with neurological deficits having normal haematological, biochemical and renal parameters preoperatively can have adverse outcomes due to hitherto unknown factors. These study demonstrated that perioperative factors like episodes of hypotension, large volume intra–operative blood loss (>1000 ml) and large volume blood/blood products (>1000 ml) are important factors and lead to unmasking of the compensated state of renal function leading to adverse outcomes. The proposed mechanism for this outcome could be degradation products of blood, overload of proteins in the circulating blood which has a detrimental effect on the renal function and disturbance in the renin–angiotensin mechanism controlled by the kidneys causing refractory hypotension are causes of adverse outcome in a subgroup of patients with solitary spinal plasmacytoma.