Background:

Stroke is a potentially life-threatening condition that can lead to disability and prolonged hospital stay. Perioperative stroke is a rare complication of spine surgery, especially in elective procedures. The prevalence of this complication varies in the literature, and the physiopathology is uncertain in many cases.

Objectives:

To describe five cases of patients who underwent spine surgery complicated by perioperative stroke and to analyze their characteristics and clinical outcomes.

Methods:

We retrospectively analyzed data from spine surgeries performed at a single institution from January 2016 to December 2019. Patients who presented with perioperative stroke were included. Data related to patient demographics, postoperative status, hospital stay, type of surgery, American Society of Anesthesiologists (ASA) score, neurological status at discharge, and mortality were registered.

Results:

Five of 1002 consecutive patients (0.49%) had complication of stroke during surgery. The surgeries included occipitocervical fusion, anterior cervical fusion, lumbar fusion, lumbosacral fusion, and thoracolumbar fusion. The mean age of patients was 52.2 ± 15.73 years (range 39-78 years), and the mean time of hospitalization was 20 ± 26.93 days (range 6-68 days). The majority of patients were females (80%). Three patients (60%) presented with ischemic stroke, and two patients (40%) had hemorrhagic stroke. Two patients were severely disabled, and three showed good neurological outcomes; no in-hospital deaths were observed. The etiology of stroke remained uncertain in the majority of cases.

Conclusions:

Despite the rarity of this complication, perioperative stroke in spine surgery can lead to considerable morbidity. Precocious diagnosis and treatment may improve patient outcomes.