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Lv H, Zhang Z, Yang A, Zhou J, Guo Y, Luo F, Zhang Z, Zhang Z, Xu J. Delayed postoperative neurological deficits from scoliosis correction: a case series and systematic review on clinical characteristics, treatment, prognosis, and recovery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2721-2733. [PMID: 38809439 DOI: 10.1007/s00586-024-08296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/02/2024] [Accepted: 05/01/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE This study was designed to investigate the clinical features, treatment modalities, and risk factors influencing neurological recovery in patients who underwent scoliosis correction with delayed postoperative neurological deficit (DPND). METHODS Three patients with DPND were identified from 2 central databases for descriptive analysis. Furthermore, all DPND cases were retrieved from the PubMed and Embase databases. Neurological function recovery was categorized into complete and incomplete recovery groups based on the American Spinal Injury Association (ASIA) impairment scale. RESULTS Two patients were classified as type 3, and one was classified as type 2 based on the MRI spinal cord classification. Intraoperative neurophysiological monitoring (IONM) was consistently negative throughout the corrective procedure, and intraoperative wake-up tests were normal. The average time to DPND development was 11.8 h (range, 4-18 h), and all three patients achieved complete recovery of neurological function after undergoing revision surgery. A total of 14 articles involving 31 patients were included in the literature review. The mean time to onset of DPND was found to be 25.2 h, and 85.3% (29/34) of patients experienced DPND within the first 48 h postoperatively, with the most common initial symptoms being decreased muscle strength and sensation (26 patients, 83.9%). Regarding neurological function recovery, 14 patients were able to reach ASIA grade E, while 14 patients were not able to reach ASIA grade E. Univariate analysis revealed that preoperative diagnosis (p = 0.004), operative duration (p = 0.017), intraoperative osteotomy method (p = 0.033), level of neurological deficit (p = 0.037) and deficit source (p = 0.0358) were significantly associated with neurological outcomes. Furthermore, multivariate regression analysis indicated a strong correlation between preoperative diagnosis (p = 0.003, OR, 68.633; 95% CI 4.299-1095.657) and neurological prognosis. CONCLUSION Our findings indicate that spinal cord ischemic injury was a significant factor for patients experiencing DPND and distraction after corrective surgery may be a predisposing factor for spinal cord ischemia. Additionally, it is important to consider the possibility of DPND when limb numbness and decreased muscle strength occur within 48 h after corrective scoliosis surgery. Moreover, emergency surgical intervention is highly recommended for DPND caused by mechanical compression factors with a promising prognosis for neurological function, emphasizing the importance of taking into account preoperative orthopedic diagnoses when evaluating the potential for neurological recovery.
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Affiliation(s)
- Hui Lv
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China
| | - ZhongRong Zhang
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China
| | - AiJun Yang
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China
| | - JianHong Zhou
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China
| | - Yuan Guo
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China
| | - Fei Luo
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China
| | - ZhengFeng Zhang
- Department of Orthopedics, Xinqiao Hospital, 183 Xinqiao Main Street, Shapingba District, Chongqing, 400037, China
| | - ZeHua Zhang
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China.
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China.
| | - JianZhong Xu
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China.
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China.
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Rutges JPHJ, Renkens JJM, Kempen DHR, Faber C, Stadhouder A, Kruyt MC, Mostert A, Horsting PP, de Klerk LWL, de Kleuver M, Castelein RM, Schlösser TPC. The risk of delayed spinal cord injury in pediatric spinal deformity surgery. Spine Deform 2022; 11:617-625. [PMID: 36459389 DOI: 10.1007/s43390-022-00626-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/14/2022] [Indexed: 12/04/2022]
Abstract
Delayed spinal cord injury (SCI) hours or days after surgery, with uneventful monitoring and initial normal postoperative neurological examination, is a rare complication. Based on anecdotal evidence, the risk of delayed spinal cord injury might be higher than previously assumed. Therefore the aim of this study was to determine the risk of delayed SCI after pediatric spinal deformity surgery between 2013-2019 in the Netherlands. The total number of pediatric spinal deformity surgeries performed for scoliosis or kyphosis between 2013-2019 was obtained from the Dutch National Registration of Hospital Care. All eleven Dutch hospitals that perform pediatric spinal deformity surgery were contacted for occurrence of delayed SCI. From the identified patients with delayed SCI, the following data were collected: patient characteristics, details about the SCI, the surgical procedure, management and degree of improvement.2884 pediatric deformity surgeries were identified between 2013-2019. Seven patients (0.24%) with delayed SCI were reported: 3 idiopathic, 2 neuromuscular (including 1 kypho-scoliosis) and 2 syndromic scoliosis. The risk of delayed SCI after pediatric deformity surgery was 1:595 in idiopathic scoliosis, 1:214 in syndromic scoliosis, 1:201 in neuromuscular scoliosis. All seven patients had a documented normal neurological examination in the first postoperative period; neurological deficits were first diagnosed at a median 16h (range 2.5-40) after surgery. The risk of delayed SCI after pediatric deformity surgery is higher than previously reported, especially in patients with non-idiopathic scoliosis. Regular postoperative testing for late neurologic deficit should be performed for timely diagnosis and management of this devastating complication.
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Affiliation(s)
- J P H J Rutges
- Department of Orthopedics and Sports Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - J J M Renkens
- Department of Orthopedics and Sports Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - D H R Kempen
- Department of Orthopedics, Onze Lieve Vrouwe Gasthuis OLVG, Amsterdam, The Netherlands
| | - C Faber
- Department of Orthopedics, UMC Groningen, Groningen, The Netherlands
| | - A Stadhouder
- Department of Orthopedics, Amsterdam UMC, Amsterdam, The Netherlands
| | - M C Kruyt
- Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - A Mostert
- Department of Orthopedics, Isala Zwolle, Zwolle, The Netherlands
| | - P P Horsting
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - L W L de Klerk
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - M de Kleuver
- Department of Orthopedics, Radboud UMC, Nijmegen, The Netherlands
| | - R M Castelein
- Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - T P C Schlösser
- Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
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Lovi A, Manfroni F, Luca A, Babbi L, Brayda-Bruno M. Delayed postoperative cervical spinal cord ischemic lesion after a thoracolumbar fusion for syndromic scoliosis: a case report and systematic review of the literature. Childs Nerv Syst 2022; 38:1011-1015. [PMID: 34559301 DOI: 10.1007/s00381-021-05336-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION We report a case and a literature review of delayed postoperative cervical spinal cord injury after thoraco-lumbar spine surgery. CASE REPORT A 13-year-old Prader-Willi Syndrome female was treated by a T3-L5 posterior spine fusion for progressive scoliosis. Intraoperative neuromonitoring and immediate postoperative neurological examination were normal. Sixty hours after surgery, she developed a tetraplegia. The immediate MRI and CT scan of the spine were negative. Two days after, a new MRI revealed an ischemic cervical lesion at the level C5-C6. After 1 week, she gradually improved breathing and motility/sensibility at the extremities. After 4 months of intensive neurologic rehabilitation, the patient improved to ASIA grade D and was discharged. At 1-year follow, the neurologic recovery was nearly completed. METHODS We performed a systematic review of the literature through PubMed and Embase database focused on delayed postoperative cervical spinal cord lesion after a thoraco-lumbar fusion for spinal deformity. RESULTS Only 14 cases of neurological injuries at levels above the site of surgery have been previously reported and never in Prader Willy Syndrome. All patients were adolescent and 86,7% were females but no specific risk factors were found. CONCLUSIONS Delayed postoperative neurological deficit far from the surgical site can be considered a specific subgroup of these rare complication that can occur several hours after spine surgery, regardless of intraoperative complication. Despite the rarity of this complication, clinicians should be aware of it. Perioperative optimization of spinal cord perfusion and close neurological examination in first postoperative days may be helpful to quickly recognize and treat this complication.
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Affiliation(s)
- Alessio Lovi
- Spine Surgery Unit III-Scoliosis, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Francesca Manfroni
- Spine Surgery Unit III-Scoliosis, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
| | - Andrea Luca
- Spine Surgery Unit III-Scoliosis, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Lisa Babbi
- Spine Surgery Unit III-Scoliosis, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Marco Brayda-Bruno
- Spine Surgery Unit III-Scoliosis, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
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