To the Editor: 

I read with interest the recent editorial by Lanier and Warner of the Mayo Clinic on new perioperative cervical injury.1The authors state in a somewhat cavalier manner that “Spinal cord injury associated with airway instrumentation was uncommon, accounting for a mere 11% of patients.1” They seem to be suggesting that anesthesia providers do not need to be greatly concerned with these injuries, and they compare them with postoperative ulnar nerve injuries. They cite a study from their institution that they claim dismisses the culpability of anesthesia providers as the cause of these postoperative ulnar nerve injuries because “… ulnar injuries were never present at the completion of surgery, and most did not appear until 1 or 2 days after surgery.2” However, Miller and Camp have indicated that ulnar injuries were noted in five patients immediately upon awakening from general anesthesia and were attributed to preventable errors.3 

Lanier and Warner state “We wonder whether future research will also lessen the culpability and legal risk of anesthesia providers regarding new onset cervical injuries.1” I suggest that anesthesiologists maintain a careful and cautious approach in an attempt to prevent both neck and ulnar nerve injuries by using every means at their disposal to lessen the incidence of these serious and persistent problems.

Campus Eye Group, Hamilton Square, New Jersey.

Lanier WL, Warner MA: New perioperative cervical injury: Medical and legal implications for patients and anesthesia providers. ANESTHESIOLOGY 2011; 114:729–31
Warner MA, Warner DO, Matsumoto JY, Harper CM, Schroeder DR, Maxson PM: Ulnar neuropathy in surgical patients. ANESTHESIOLOGY 1999; 90:54–9
Miller RG, Camp PE: Postoperative ulnar neuropathy. JAMA 1979; 242:1636–9