Risk Factors for Neurological Complications in Severe and Rigid Spinal Deformity Correction of 177 Cases

Overview

Journal BMC Neurol

Publisher Biomed Central

Specialty Neurology

Date 2020 Nov 28

PMID 33246421

Citations 7

Authors

Jian Chen

Xie-Xiang Shao

Wen-Yuan Sui

Jing-Fan Yang

Yao-Long Deng

Jing Xu

Zi-Fang Huang

Jun-Lin Yang

Affiliations

Soon will be listed here.

Abstract

Background: Difficult procedures of severe rigid spinal deformity increase the risk of intraoperative neurological injury. Here, we aimed to investigate the preoperative and intraoperative risk factors for postoperative neurological complications when treating severe rigid spinal deformity.

Methods: One hundred seventy-seven consecutive patients who underwent severe rigid spinal deformity correction were assigned into 2 groups: the neurological complication (NC, 22 cases) group or non-NC group (155 cases). The baseline demographics, preoperative spinal cord functional classification, radiographic parameters (curve type, curve magnitude, and coronal/sagittal/total deformity angular ratio [C/S/T-DAR]), and surgical variables (correction rate, osteotomy type, location, shortening distance of the osteotomy gap, and anterior column support) were analyzed to determine the risk factors for postoperative neurological complications.

Results: Fifty-eight patients (32.8%) had intraoperative evoked potentials (EP) events. Twenty-two cases (12.4%) developed postoperative neurological complications. Age and etiology were closely related to postoperative neurological complications. The spinal cord functional classification analysis showed a lower proportion of type A, and a higher proportion of type C in the NC group. The NC group had a larger preoperative scoliosis angle, kyphosis angle, S-DAR, T-DAR, and kyphosis correction rate than the non-NC group. The results showed that the NC group tended to undergo high-grade osteotomy. No significant differences were observed in shortening distance or anterior column support of the osteotomy area between the two groups.

Conclusions: Postoperative neurological complications were closely related to preoperative age, etiology, severity of deformity, angulation rate, spinal cord function classification, intraoperative osteotomy site, osteotomy type, and kyphosis correction rate. Identification of these risk factors and relative development of surgical techniques will help to minimize neural injuries and manage postoperative neurological complications.

Citing Articles

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Management Principles in a Case of True-positive Loss of Neuromonitoring Signals during Scoliosis Surgery: A Case Report.

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Sequential correction of severe and rigid kyphoscoliosis: a new technical note and preliminary results.

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Type 3 bone-disc-bone osteotomy (grade 4+ osteotomy) combined with presurgical halo-pelvic traction: a safe and effective solution to correct severe angular-like kyphoscoliosis.

Zhang T, Sui W, Shao X, Deng Y, Huang Z, Yang J Quant Imaging Med Surg. 2023; 13(7):4196-4204.

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Clinical Application of Personalized Digital Surgical Planning and Precise Execution for Severe and Complex Adult Spinal Deformity Correction Utilizing 3D Printing Techniques.

Ding H, Hai Y, Zhou L, Liu Y, Zhang Y, Han C J Pers Med. 2023; 13(4).

PMID: 37108989 PMC: 10143551. DOI: 10.3390/jpm13040602.

References

Lawton M, Porter R, Heiserman J, JACOBOWITZ R, Sonntag V, Dickman C . Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg. 1995; 83(1):1-7. DOI: 10.3171/jns.1995.83.1.0001. View

Fan H, Li X, Huang Z, Sui W, Yang J, Deng Y . Radiologic Parameters Can Affect the Preoperative Decision Making of Three-Column Spinal Osteotomies in the Treatment of Severe and Stiff Kyphoscoliosis. Spine (Phila Pa 1976). 2017; 42(23):E1371-E1379. DOI: 10.1097/BRS.0000000000002210. View

Chang K, Cheng C, Chen H, Chen T . Correction hinge in the compromised cord for severe and rigid angular kyphosis with neurologic deficits. Spine (Phila Pa 1976). 2009; 34(10):1040-5. DOI: 10.1097/BRS.0b013e31819c105f. View

Cohen D, Cuffin B . Developing a more focal magnetic stimulator. Part I: Some basic principles. J Clin Neurophysiol. 1991; 8(1):102-11. DOI: 10.1097/00004691-199101000-00013. View

Panjabi M, Takata K, Goel V, FEDERICO D, Oxland T, Duranceau J . Thoracic human vertebrae. Quantitative three-dimensional anatomy. Spine (Phila Pa 1976). 1991; 16(8):888-901. DOI: 10.1097/00007632-199108000-00006. View

Sui W, Huang Z, Deng Y, Fan H, Yang J, Li F . The Safety and Efficiency of PVCR without Anterior Support Applied in Treatment of Yang Type A Severe Thoracic Kyphoscoliosis. World Neurosurg. 2017; 104:723-728. DOI: 10.1016/j.wneu.2017.05.063. View

Huang Z, Yang J, Sui W, Fan H, Deng Y, Yang J . Surgical Outcome Comparison of Posterior Vertebral Column Resection with or without Anterior Column Support in Treatment of Yang's Type A Severe Thoracic Spinal Deformity. World Neurosurg. 2018; 121:e433-e440. DOI: 10.1016/j.wneu.2018.09.135. View

Boe C, Freedman B, Kumar R, Lee K, McDonald R, Port J . Spinal subdural hematoma: a rare case of spinal subdural hematoma complicating routine, minimally invasive lumbar discectomy and decompression and relevant literature review. J Spine Surg. 2017; 3(1):112-118. PMC: 5386888. DOI: 10.21037/jss.2017.03.01. View

Song K, Chang B, Yeom J, Lee J, Park K, Lee C . Surgical treatment of severe angular kyphosis with myelopathy: anterior and posterior approach with pedicle screw instrumentation. Spine (Phila Pa 1976). 2008; 33(11):1229-35. DOI: 10.1097/BRS.0b013e31817152b3. View

10.

Zhang Z, Wang H, Liu C . Compressive myelopathy in severe angular kyphosis: a series of ten patients. Eur Spine J. 2015; 25(6):1897-903. DOI: 10.1007/s00586-015-4051-6. View

11.

Spanier D, Stambough J . Delayed postoperative epidural hematoma formation after heparinization in lumbar spinal surgery. J Spinal Disord. 2000; 13(1):46-9. DOI: 10.1097/00002517-200002000-00010. View

12.

Bridwell K, Lenke L, Baldus C, Blanke K . Major intraoperative neurologic deficits in pediatric and adult spinal deformity patients. Incidence and etiology at one institution. Spine (Phila Pa 1976). 1998; 23(3):324-31. DOI: 10.1097/00007632-199802010-00008. View

13.

Kim S, Cho B, Kim J, Lim D, Park J, Lee B . Complications of posterior vertebral resection for spinal deformity. Asian Spine J. 2013; 6(4):257-65. PMC: 3530700. DOI: 10.4184/asj.2012.6.4.257. View

14.

Wang P, Ma K, Chen T, Xue X, Ma D, Wang S . Risk factor analysis for progressive spinal deformity after resection of intracanal tumors─ a retrospective study of 272 cases. BMC Neurol. 2020; 20(1):34. PMC: 6977227. DOI: 10.1186/s12883-019-1594-x. View

15.

Kamerlink J, Errico T, Xavier S, Patel A, Patel A, Cohen A . Major intraoperative neurologic monitoring deficits in consecutive pediatric and adult spinal deformity patients at one institution. Spine (Phila Pa 1976). 2010; 35(2):240-5. DOI: 10.1097/BRS.0b013e3181c7c8f6. View

16.

Yang J, Huang Z, Yin J, Deng Y, Xie X, Li F . A proposed classification system for guiding surgical strategy in cases of severe spinal deformity based on spinal cord function. Eur Spine J. 2016; 25(6):1821-9. DOI: 10.1007/s00586-015-4367-2. View

17.

McMaster M, Singh H . Natural history of congenital kyphosis and kyphoscoliosis. A study of one hundred and twelve patients. J Bone Joint Surg Am. 1999; 81(10):1367-83. DOI: 10.2106/00004623-199910000-00002. View

18.

Lewis N, Keshen S, Lenke L, Zywiel M, Skaggs D, Dear T . The Deformity Angular Ratio: Does It Correlate With High-Risk Cases for Potential Spinal Cord Monitoring Alerts in Pediatric 3-Column Thoracic Spinal Deformity Corrective Surgery?. Spine (Phila Pa 1976). 2015; 40(15):E879-85. DOI: 10.1097/BRS.0000000000000984. View

19.

Li X, Huang Z, Deng Y, Fan H, Sui W, Wang C . Computed Tomography Based Three-dimensional Measurements of Spine Shortening Distance After Posterior Three-column Osteotomies for the Treatment of Severe and Stiff Scoliosis. Spine (Phila Pa 1976). 2017; 42(14):1050-1057. DOI: 10.1097/BRS.0000000000002117. View

20.

Harrop J, Chi J, Anderson P, Arnold P, Dailey A, Dhall S . Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Evaluation and Treatment of Patients With Thoracolumbar Spine Trauma: Neurological Assessment. Neurosurgery. 2018; 84(1):E32-E35. DOI: 10.1093/neuros/nyy370. View