Back Pain, Neck Pain, and Spinal Canal Syndromes

Acute spinal cord injury is discussed earlier in the section on autonomic dysfunction. Although it is a common problem, little is written about the anesthetic management of syndromes related to herniated disks, spondylosis (usually of advancing age), and the congenital narrowing of the cervical and lumbar canal that gives rise to symptoms of nerve root compression.^{[649] [650]} One report stresses the importance of the vascular component in the mechanism of damage to the spinal cord and, hence, the theoretical desirability of slight hypertension perioperatively.^[651] Another report suggests the use of awake intubation, a fiberoptic bronchoscope, and evoked potential monitoring.^[649] Preoperative management of a patient about to undergo chemonucleolysis is discussed earlier in the section on anaphylaxis. Other than the commonsense approach of seeking neurologic consultation or, if necessary, using awake positioning of patients in a comfortable position before emergency root decompression procedures, no special procedures appear to be necessary.