The risk of paraplegia through medical treatment

In the Orthopedic University Hospital of Heidelberg (section Orthopedics II , treatment and rehabilitation of paraplegia), 21 patients with iatrogenic paraplegia were treated between 1968 and 1991. Paraplegia occurred in nine cases after procedures dose to the spinal cord. In 12 cases paraplegia comp licated medical treatment. Procedures close to the spinal cord, such as lam inectomy, vertebrotomy, spondylodesis, and peridural anaesthesia, involve t he risk of mechanical damage to the spinal cord, the level of paraplegia de pends on the area of treatment. Any previous damage to the spinal cord incr eases the risk of paraplegic complications, The main risks in procedures di stant from the spinal cord, such as vascular surgery, angiography, radiothe rapy, bronchial artery embolisation, and umbilical artery injection, are di sturbances of the blood supply or toxic mechanisms. The ischaemic genesis o f spinal cord damage is obvious in the case of vessel ligatures or cross-cl amping of the aorta with resulting hypotonic discirculation. In radiomyelop athy as well, the damage to the spinal vessels outweighs the direct neurona l damage. Corresponding to the vascular cause, lesions are more likely to o ccur at. the level of borderlines of blood supply in the middle thoracic co rd or in the area of a non-anastomosed great radicular artery in the lumbar spinal cord. Knowledge of the consequences and side effects of medical tre atment is imperative. Knowing about the risk of a paraplegic lesion, we nee d a strict indication for diagnostic and therapeutic interventions. Due to progress in science some of the reasons of iatrogenic paraplegia have becom e manageable. Especially in radiotherapy, vascular surgery and angiography the risk of neurological complications has been lowered.