EVALUATION OF AETIOLOGICAL FACTORS IN ADVERSE OUTCOME FOR NEUROSURGICAL INTERVENTION IN PATIENTS OF SOLITARY SPINAL PLASMACYTOMA WITH NEUROLOGICAL DEFICITS.

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 decits 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 decits from a cohort of all patients with presenting with vertebral 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 intraoperative
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 prole in all the 11 patients.
Conclusions: This study revealed that in patients of solitary spinal plasmacytoma with neurological decits 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.