Delayed Postoperative Neurologic Deficit After Spine Deformity Surgery: Analysis of 5377 Cases at 1 Institution

Qiao, Jie; Xiao, Liangyan; Zhu, Zezhang; Xu, Leilei; Qian, Bangping; Liu, Zhen; Sun, Xu; Qiu, Yong

doi:10.1016/j.wneu.2017.12.010

Cited by 11 publications

(14 citation statements)

References 19 publications

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“…Wang et al 11 assumed that the increasing stretching force in spinal cord during VCR was probably the major reason for IOM loss. Based on our clinical practice, we believed that other possible mechanisms including directly mechanical injury, low mean arterial pressure, 14 spinal cord kinking because of overshorting or overcorrection, 15,16 hematoma, 17 and injury of segmental vessels 18 should not be neglected as well. In addition, though MEPs seemed to be more sensitive to the change of spinal stretching force than SEPs, multiple IONM models at least including SEPs, MEPs, and electromyogram should always be recommended.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Neurophysiological Monitoring Alerts During Three-Column Osteotomy: Incidence and Risk Factors

Liu

Qiu²,

Zhu³

et al. 2022

Journal of Clinical Neurophysiology

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Prupose: To analyze the incidence and risk factors of intraoperative neurophysiological monitoring (IONM) alerts in patients undergoing three-column osteotomy.Methods: A total of 551 patients (340 males and 211 females) with an average age of 31.9 years undergoing posterior 3-column osteotomy were retrospectively reviewed. The coronal Cobb angle of main curve and sagittal global kyphosis were measured on preoperative standing whole spinal x-rays. The Frankel scores at preoperation, postoperation, and the last follow-up were recorded and applied for assessment of neurologic status. Surgical procedures and other factors associated with IONM alerts were analyzed.Results: A total of 98 (17.8%) IONM alerts were reported during surgery, including 82 somatosensory evoked potential alerts and 91 motor evoked potential alerts. Positive wake-up test was revealed in 57 patients (10.3%) even after prompt managements, and new neurologic deficits were observed in 50 patients (9.1%) at immediate postoperation. Of the 50 patients with new neurologic deficits at postoperation, the Frankel scores were A in 5 patients, B in 4, C in 9, and D in 32. The x 2 test showed that patients with congenital deformities, global kyphosis .908, vertebral column resection procedure, cervicothoracic/thoracic osteotomy, blood loss .3,000 mL, and preoperative neurologic deficit were at a higher risk of IONM alerts. Conclusions:The incidence of IONM alerts in patients undergoing 3-column osteotomy was 17.8%. Congenital deformities, global kyphosis .908, vertebral column resection, cervicothoracic/thoracic osteotomy, blood loss .3,000 mL, and preoperative neurologic deficit indicated high risk of IONM alerts.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Neurophysiological Monitoring Alerts During Three-Column Osteotomy: Incidence and Risk Factors

Liu

Qiu²,

Zhu³

et al. 2022

Journal of Clinical Neurophysiology

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“…Pediatric deformity surgery is challenging and is among the most invasive surgeries performed in children [5,6]. Complication rates for pediatric spinal deformity surgery have been reported as high as 22% and 7.6% for AIS specifically; respiratory failure, reintubation, and implant-related complications are some of the most commonly reported complications [3,4,7].…”

Section: Introductionmentioning

confidence: 99%

“…However, reported risks range from 0.2 to 0.7%, the majority of the injuries are incomplete and at least partially recover in the months after surgery [3]. Most common causes are direct trauma to or compression of the cord due to implant malposition (screw or hook, stretch by the correction manoeuvre or ischemia of the spinal cord [6,8]. The early SCI is usually identified during surgery by the multimodal intraoperative neuromonitoring or immediately after surgery at the postoperative neurological examination [6].…”

Section: Introductionmentioning

confidence: 99%

“…Most common causes are direct trauma to or compression of the cord due to implant malposition (screw or hook, stretch by the correction manoeuvre or ischemia of the spinal cord [6,8]. The early SCI is usually identified during surgery by the multimodal intraoperative neuromonitoring or immediately after surgery at the postoperative neurological examination [6]. Nevertheless, a much more uncommon form of neurological deficit has also been reported, delayed SCI.…”

Section: Introductionmentioning

confidence: 99%

“…Delayed SCI is defined as a neurological deficit that develops hours to days after uneventful surgery with stable neuromonitoring and a normal postoperative neurologic examination [6,7,[9][10][11][12]. Delayed SCI typically develops within 4 days after surgery and is in 74-86% of the cases incomplete [6,7].…”

Section: Introductionmentioning

confidence: 99%

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The risk of delayed spinal cord injury in pediatric spinal deformity surgery

et al. 2022

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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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Transcranial Motor-Evoked Potentials

Jameson

2022

Koht, Sloan, Toleikis's Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals

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Delayed Postoperative Neurologic Deficit After Spine Deformity Surgery: Analysis of 5377 Cases at 1 Institution

Cited by 11 publications

References 19 publications

Intraoperative Neurophysiological Monitoring Alerts During Three-Column Osteotomy: Incidence and Risk Factors

Intraoperative Neurophysiological Monitoring Alerts During Three-Column Osteotomy: Incidence and Risk Factors

The risk of delayed spinal cord injury in pediatric spinal deformity surgery

Transcranial Motor-Evoked Potentials

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