Is There a Risk of Stroke During Anterior Cervical Discectomy? A Randomized Controlled Trial.

Aim: To examine the effects of different retractor techniques for anterior cervical discectomy on cerebral oxygen saturation.

Material And Methods: In this study, a prospective comparative design was employed to examine the effects of different retractor techniques on a cohort of 48 adult patients with ASA I-II classification who underwent anterior cervical discectomy under general anesthesia. The study was conducted under assessor-blinded conditions, and the patients were divided equally into two groups: the self-retaining retractor group and the hand-held retractor group. In addition to standard anaesthesia monitoring, the utilization of cerebral oximetry monitoring was implemented for all patients. A total of 7 measurements were obtained at various stages, including preoperative, during anaesthesia induction, surgical positioning, surgical retraction, release of retractors, after correction of extension position, and prior to extubation. The main objective of this study was to evaluate the impact of neck position and surgical retraction on brain perfusion, as measured by regional cerebral oximetry.

Results: Sociodemographic data, duration of operation, hemodynamic parameters, bilateral regional cerebral oxygen saturation (rScO), and Mini Mental State Examination (MMSE) scores did not differ significantly between the two groups. In both groups, the bilateral rScO decreased significantly with positioning and the left rScO decreased significantly following the installation of retractors. Only the left rScO increased significantly upon the release of both retractors. Following the correction of the neck position, bilateral rScO increased significantly in both groups (p < 0.001).

Conclusion: The rScO of the left carotid artery was shown to significantly decrease due to the indirect impact of the retractors. After extending the head and neck, bilateral rScO values decreased significantly in both groups. However, despite this decline, there was no significant decrease in brain perfusion that would result in ischemia. The absence of a statistically significant distinction between the groups implies that it is unlikely to have an impact on brain perfusion.