Delayed Postoperative Paraplegia with Hypotension in Adult Revision Scoliosis Surgery

Taylor, BA; Pj, Webb; Hetreed, M.; Rd, Mulukutla; Farrell, John W

doi:10.1097/00007632-199402001-00019

Cited by 48 publications

(19 citation statements)

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“…Three delayed neurological complications following spinal surgery, two of which purely motor, have been mentioned but not further discussed, in a previous paper 1. Delayed postoperative paraplegia has also been reported in a 46 year old woman following revision of scoliosis surgery 2. Neurological deficits begun three and a half hours after skin closure and coincided with a fall in blood pressure probably caused by hypovolaemia.…”

Section: Discussionmentioning

confidence: 92%

Neurological complications of anterior spinal surgery for kyphosis with normal somatosensory evoked potentials (SEPs)

Pelosi

Jardine

Webb

1999

Journal of Neurology, Neurosurgery & Psychiatry

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We report a case of neurological complications of anterior release for correction of kyphosis. After the operation, the patient had pyramidal weakness and decreased pain sensation below T5, whereas light touch, proprioception and vibration sensation were intact. Clinical and neurophysiological findings in this patient suggested a partial lesion of the spinal cord probably due to ischaemia in the territory of the anterior spinal artery. Intraoperative and postoperative tibial nerve SEPs remained normal, which stresses the need for recording from the motor pathways. (J Neurol Neurosurg Psychiatry 1999;66:662-664)

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Section: Discussionmentioning

confidence: 92%

Neurological complications of anterior spinal surgery for kyphosis with normal somatosensory evoked potentials (SEPs)

Pelosi

Jardine

Webb

1999

Journal of Neurology, Neurosurgery & Psychiatry

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“…The aetiology of neurological damage during spine or spinal cord surgery includes direct or indirect trauma to neural elements, 16,17 ischaemia, compression, overdistraction, 3 intraoperative or postoperative hypotension, 18,19 bleeding 20 or metabolic imbalances. 21 Consequently, the use of intraoperative neurophysiologic monitoring allows for the identification of any change at a still reversible stage, permitting a prompt correction of the cause avoiding permanent neurological impairment.…”

Section: Discussionmentioning

confidence: 99%

Somatosensory- and motor-evoked potential monitoring during spine and spinal cord surgery

et al. 2006

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Objectives: Complex spinal surgery carries a significant risk of neurological damage. The aim of this study is to determine the reliability and applicability of multimodality motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs) monitoring during spine and spinal cord surgery in our institute. Methods: Recordings of MEPs to multipulse transcranial electrical stimulation (TES) and cortical SEPs were made on 52 patients during spine and spinal cord surgery under propofol/ fentanyl anaesthesia, without neuromuscular blockade. Results: Combined MEPs and SEPs monitoring was successful in 38/52 patients (73.1%), whereas only MEPs from at least one of the target muscles were obtained in 12 patients (23.1%); both MEPs and SEPs were absent in two (3.8%). Significant intraoperative-evoked potential changes occurred in one or both modalities in five (10%) patients. Transitory changes were noted in two patients, whereas three had persistent changes, associated with new deficits or a worsening of the pre-existing neurological disabilities. When no postoperative changes in MEP or MEP/SEP modalities occurred, it was predictive of the absence of new motor deficits in all cases. Conclusion: Intraoperative combined SEP and MEP monitoring is a safe, reliable and sensitive method to detect and reduce intraoperative injury to the spinal cord. Therefore, the authors suggest that a combination of SEP/MEP techniques could be used routinely during complex spine and/or spinal cord surgery.Spinal Cord (2007) 45, 86-91.

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“…Neurogenic intermittent claudication (NIC) secondary to lumbar spinal stenosis (LSS) is a degenerative disease prevalent in the population older than 50 years of age [1], with about 8 % of adult population affected by this pathology [2]. …”

Section: Introductionmentioning

confidence: 99%

Lumbar spinal stenosis treatment with aperius perclid interspinous system

et al. 2012

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PurposeThe purpose of this study is to report clinical outcome and imaging changes of percutaneous Aperius stand-alone implant in patients with degenerative lumbar spinal stenosis and neurogenic intermittent claudication, which did not respond to conservative treatment.MethodBetween January 2008 and July 2010, 37 patients (20 males and 17 females) with mean age of 64.3 years underwent surgery for the onset of claudicatio spinalis with Aperius PercLID interspinous device (Medtronic). In all patients, the diagnosis was: foraminal stenosis, in one case (2.7 %) it was associated to a degenerative anterior listhesis (I grade), in three cases (8.1 %) it was associated to an intraforaminal disc herniation. The mean follow-up was of 18 months (range 2–35 months). The patients were evaluated through the Oswestry disability index, Zurich Claudication Questionnaire (ZCQ), VAS scales. In all cases were obtained preoperative and in postoperative radiographs and magnetic resonance imaging.ResultsThe VAS score decreased significantly after surgery: the patients presented a mean VAS of seven preoperatively and two postoperatively (p < 0.001).The ZCQ score significantly decreased postoperatively, with an average reduction of 21.89 % (p < 0.001).The ODI score as well showed a significant reduction postoperatively of an average 26.09 % (p < 0.001).ConclusionDespite of the brief follow up, the preliminary results are encouraging, showing a significantly decrease of the disability parameters, a marked improvement of the function with the vanishing of the claudicatio spinalis and the following increase of the free interval during the walk. Aperius PercLID system seems to offer an alternative to the traditional decompression surgery.

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Delayed Postoperative Paraplegia with Hypotension in Adult Revision Scoliosis Surgery

Cited by 48 publications

References 0 publications

Neurological complications of anterior spinal surgery for kyphosis with normal somatosensory evoked potentials (SEPs)

Neurological complications of anterior spinal surgery for kyphosis with normal somatosensory evoked potentials (SEPs)

Somatosensory- and motor-evoked potential monitoring during spine and spinal cord surgery

Lumbar spinal stenosis treatment with aperius perclid interspinous system

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