Spinal cord ischemia after post-chemotherapy retroperitoneal lymph node dissection for nonseminomatous germ cell cancer

Purpose: We report and analyze several cases of neurological deficit after post-chemotherapy retroperitoneal lymph node dissection that were thought to be related to spinal cord ischemia. Materials and Methods: We searched the testis cancer data base at our university, which includes 1,447 retroperitoneal lymph node dissections performed from 1982 to 1994, to identify patients who had postoperative neurological complications. The history and clinical course of patients suspected to have spinal cord ischemia were reviewed and potential risk factors were analyzed. Results: The incidence of spinal cord ischemia after post-chemotherapy retroperitoneal lymph node dissection was 0.56% (4 of 712 patients). Conclusions: Spinal cord ischemia may complicate the course of post-chemotherapy retroperitoneal lymph node dissection in testis cancer patients. Older age, extensive retroperitoneal dissection, prior therapy and certain anesthetic parameters may predispose nonseminomatous germ cell tumor patients to spinal cord ischemia. These risk factors may be used to define a subset of high risk patients, and active measures should be taken in an attempt to minimize the frequency of spinal cord ischemia in these patients.