A preliminary study of spinal cord blood flow during PVCR with spinal column shortening

Abstract

Posterior vertebral column resection (PVCR) was the most powerful technique for treating severe rigid spinal deformity, but it has been plagued with high neurologic deficits risk. The fluctuations of spinal cord blood flow (SCBF) play an important role in secondary spinal cord injury during deformity correction surgery. The objective of this study was to first provide the characteristic of SCBF during PVCR with spinal column shortening in severe rigid spinal deformity. Severe rigid scoliokyphosis patients received PVCR above L1 level were included in this prospective study. Patients with simple kyphosis, intraspinal pathology and any degree of neurologic deficits were excluded. The deformity correction was based on spinal column shortening over the resected gap during PVCR. Laser Doppler flowmetry was used to monitor the SCBF at different surgical stages. There were 12 severe rigid scoliokyphosis patients in the study. The baseline SCBF was 316 ± 86 perfusion unite (PU), and the SCBF decreased to 228 ± 68 PU after VCR ( P = .008). The SCBF increased to 296 ± 102 PU after the middle shortening and correction which has a 121% increased comparison to the SCBF after VCR ( P = .02). The SCBF will slightly decrease to 271 ± 65 PU at final fixation. The postoperative neural physical examination of all patients was negative, and the MEP and SSEP of all patients did not reach the alarm value during surgery. These results indicate that PVCR is accompanied by a change in SCBF, a proper spinal cord shortening can protect the SCBF and can prevent a secondary spinal cord injury during the surgery.

Is There a Correlation Between Cobb Angle and Pulmonary Function Tests at 2-year Follow-up in Patients With Severe Spinal Deformity Treated by Posterior Vertebral Column Resection?

“…Despite the PF recovery, too much deformity correction may have adverse effect on the blood flow of spinal cord then cause a secondary spinal cord injury during the surgery. 36 So even though PVCR could achieve high correction rate, too much correction was not always necessary. But we need to stress here that because of the small sample size, we did not make the residual cobb angle of 30 degrees as the discriminator, we just speculated that too much correction angle may not be the best choice.…”

“…Our subgroup analysis showed that patients with residual cobb angle >30 degrees had greater PFTs values improvements than patients with residual cobb angle <30 degrees, indicated too much correction angle may to some extent reverse the benefits of deformity correction on PF. Despite the PF recovery, too much deformity correction may have adverse effect on the blood flow of spinal cord then cause a secondary spinal cord injury during the surgery 36. So even though PVCR could achieve high correction rate, too much correction was not always necessary.…”

Relationship between BMP2/9 Levels and Spinal Function and Quality of Life in Patients with Severe Scoliosis after PVCR

“…At present, surgery is the main method of treatment for patients with severe scoliosis. Among all surgical methods, PVCR is one of the most effective surgical methods for the treatment of severe scoliosis and has been universally recognized by many scholars around the world [3,4]. However, the treatment effect of PVCR on patients' spinal deformity, function, and quality of life still needs to be improved.…”

Posterior Injured Vertebra Column Resection and Spinal Shortening for Thoracolumbar Fracture Associated with Severe Spinal Cord Injury: A Retrospective Case-Control Observational Study

“…Proper range of spinal shortening brings about vasodilation of the arteries of the spinal cord, which could result in the concomitant reduction of resistance to blood flow and increase the diameter of the anterior spinal artery by 138% compared to base line. Moreover, SCBF could be increased by 111%-160% compared to the base line before shortening [ 19 , 23 , 25 ]. Based on the abovementioned studies, the spinal shortening could reduce the spinal tension and increase SCBF, which are critical for the neurological recovery in sSCI.…”

“…Effective methods urgently need to be adopted to improve the neurological deficit for thoracolumbar fractures. Posterior injured vertebra column resection (PIVCR) and spinal shortening could decompress the spinal cord circumferentially, reduce the tension of the spinal cord, improve spinal cord perfusion, and improve neurological deficit [17][18][19][20][21][22][23][24][25]. We applied PIVCR and spinal shortening to treat thoracolumbar fractures associated with sSCI and achieved significant neurological improvement.…”