New neurologic deficit and recovery rates in the treatment of complex pediatric spine deformities exceeding 100 degrees or treated by vertebral column resection (VCR)

Boachie-Adjei, Oheneba; Duah, Henry Ofori; Yankey, Kwadwo Poku; Lenke, Lawrence G.; Sponseller, Paul D.; Sucato, Daniel J.; Samdani, Amer F.; Newton, Peter O.; Shah, Suken A.; Erickson, Mark; Akoto, Harry; Sides, Brenda; Gupta, Munish C.

doi:10.1007/s43390-020-00211-4

Cited by 10 publications

(13 citation statements)

References 14 publications

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“…observation was recommended in patients without canal stenosis or compression of the spinal cord in the multicentre fox Paediatric spinal Deformity study. 36 This study has limitations. First, our findings are limited by a small sample size including a low percentage of patients with no recovery, which presented with a low coefficient of determination in the multivariate regression model.…”

Section: Discussionmentioning

confidence: 92%

“…9 this may be due to kinking of the posterior longitudinal ligament due to over-shortening. 24 Boachie-adjei et al 36 reported a 9.4% rate of neurological deficit in 286 patients treated by vertebral column resection, and 21 patients had a complete recovery. in our study, we found a lower incidence of complete recovery and a higher percentage of incomplete recovery in patients who underwent > sRs-schwab grade ii osteotomy.…”

Section: Discussionmentioning

confidence: 99%

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The prognosis and recovery of major postoperative neurological deficits after corrective surgery for scoliosis

Qian

et al. 2022

The Bone & Joint Journal

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Aims The outcome following the development of neurological complications after corrective surgery for scoliosis varies from full recovery to a permanent deficit. This study aimed to assess the prognosis and recovery of major neurological deficits in these patients, and to determine the risk factors for non-recovery, at a minimum follow-up of two years. Methods A major neurological deficit was identified in 65 of 8,870 patients who underwent corrective surgery for scoliosis, including eight with complete paraplegia and 57 with incomplete paraplegia. There were 23 male and 42 female patients. Their mean age was 25.0 years (SD 16.3). The aetiology of the scoliosis was idiopathic (n = 6), congenital (n = 23), neuromuscular (n = 11), neurofibromatosis type 1 (n = 6), and others (n = 19). Neurological function was determined by the American Spinal Injury Association (ASIA) impairment scale at a mean follow-up of 45.4 months (SD 17.2). the patients were divided into those with recovery and those with no recovery according to the ASIA scale during follow-up. Results The incidence of major deficit was 0.73%. At six-month follow-up, 39 patients (60%) had complete recovery and ten (15.4%) had incomplete recovery; these percentages improved to 70.8% (46) and 16.9% (11) at follow-up of two years, respectively. Eight patients showed no recovery at the final follow-up. The cause of injury was mechanical in 39 patients and ischaemic in five. For 11 patients with misplaced implants and haematoma formation, nine had complete recovery. Fisher’s exact test showed a significant difference in the aetiology of the scoliosis (p = 0.007) and preoperative deficit (p = 0.016) between the recovery and non-recovery groups. A preoperative deficit was found to be significantly associated with non-recovery (odds ratio 8.5 (95% confidence interval 1.676 to 43.109); p = 0.010) in a multivariate regression model. Conclusion For patients with scoliosis who develop a major neurological deficit after corrective surgery, recovery (complete and incomplete) can be expected in 87.7%. The first three to six months is the time window for recovery. In patients with misplaced implants and haematoma formation, the prognosis is satisfactory with appropriate early intervention. Patients with a preoperative neurological deficit are at a significant risk of having a permanent deficit. Cite this article: Bone Joint J 2022;104-B(1):103–111.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

The prognosis and recovery of major postoperative neurological deficits after corrective surgery for scoliosis

Qian

et al. 2022

The Bone & Joint Journal

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“…In comparison, other types of pediatric deformity have an approximately 10% incidence of residual deficits. 65,66 This might be a reflection of inconsistent data reporting throughout studies and/or be due to intraspinal dystrophic anomalies.…”

Section: Discussionmentioning

confidence: 99%

Management and surgical outcomes of dystrophic scoliosis in neurofibromatosis type 1: a systematic review

Neifert

Khan

Kurland

et al. 2022

Neurosurgical Focus

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OBJECTIVE Neurofibromatosis type 1 (NF1) dystrophic scoliosis is an early-onset, rapidly progressive multiplanar deformity. There are few studies on the surgical management of this patient population. Specifically, perioperative morbidity, instrument-related complications, and quality-of-life outcomes associated with surgical management have not been systematically evaluated. In this study, the authors aimed to perform a systematic review on the natural history, management options, and surgical outcomes in patients who underwent NF1 dystrophic scoliosis surgery. METHODS A PubMed search for articles with “neurofibromatosis” and either “dystrophic” or “scoliosis” in the title or abstract was performed. Articles with 10 or more patients undergoing surgery for NF1 dystrophic scoliosis were included. Data regarding indications, treatment details, morbidity, and outcomes were summarized and analyzed with descriptive statistics. RESULTS A total of 310 articles were identified, 48 of which were selected for full-text review; 30 studies describing 761 patients met the inclusion criteria. The mean age ranged from 7 to 22 years, and 99.7% of patients were younger than 18 years. The mean preoperative coronal Cobb angle was 75.2°, and the average correction achieved was 40.3°. The mean clinical follow-up in each study was at least 2 years (range 2.2–19 years). All patients underwent surgery with the intent of deformity correction. The scoliosis regions addressed were thoracic curves (69.6%) and thoracolumbar (11.1%) and lumbar (14.3%) regions. The authors reported on a variety of approaches: posterior-only, combined anterior-posterior, and growth-friendly surgery. For fixation techniques, 42.5% of patients were treated with hybrid constructs, 51.5% with pedicle screw–only constructs, and 6.0% with hook-based constructs. Only 0.9% of patients underwent a vertebral column resection. The nonneurological complication rate was 14.0%, primarily dural tears and wound infections. The immediate postoperative neurological deficit rate was 2.1%, and the permanent neurological deficit rate was 1.2%. Ultimately, 21.5% required revision surgery, most commonly for implant-related complications. Loss of correction in both the sagittal and coronal planes commonly occurred at follow-up. Five papers supplied validated patient-reported outcome measures, showing improvement in the mental health, self-image, and activity domains. CONCLUSIONS Data on the surgical outcomes of dystrophic scoliosis correction are heterogeneous and sparse. The perioperative complication rate appears to be high, although reported rates of neurological deficits appear to be lower than clinically observed and may be underreported. The incidence of implant-related failures requiring revision surgery is high. There is a great need for multicenter prospective studies of this complex type of deformity.

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“…Treatment of severe spinal deformity is one of the ultimate challenges for spine surgeons [ 22 ]. Literatures reported the incidence of neurological complications in spinal deformity correction surgeries was 1–27% [ 5 , 9 , 23 – 25 ], and with regard to new neurological deficits, the incidence was reported as 0.178–9.4%, and 33.6% of it was related to spinal instruments [ 9 , 23 ]. A systematic review concluded that the rate of screw malposition in scoliosis was 15.7% using CT scan [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, studies have demonstrated abnormal morphology formation in spinal deformity, which would increase the risk of neurological deficits because of pedicle screws inserting malposition [ 6 – 8 ]. To achieve a satisfying and safe correction, solid instrumented fixation by the accurate pedicle screw inserting must be required, or it would cause a range of complications including neurologic complications [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

The feasibility and efficacy of computer-assisted screw inserting planning in the surgical treatment for severe spinal deformity: a prospective study

et al. 2022

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Background The objective of the study was to explore the feasibility and efficacy of computer-assisted screw inserting planning (CASIP) in the surgical treatment for severe spinal deformity. Methods A total of 50 patients participated in this prospective cohort study. 25 patients were allocated into CASIP group and 25 patients were in Non-CASIP group. The demographic data, radiological spinal parameters were documented and analyzed. Each pedicle screw insertion was classified as satisfactory insertion or unsatisfactory insertion based on Gertzbein-Robbins classification. The primary outcome was the accuracy of pedicle screw placement. The secondary outcomes were the rate of puncturing screws, estimated blood loss, surgical time, correction rate and other radiological parameters. Results A total of 45 eligible patients completed the study. 20 patients were in CASIP group and 25 patients were in Non- CASIP group. The accuracy of pedicle screw placement in CASIP Group and Non-CASIP Group were (92.0 ± 5.5) % and (82.6 ± 8.3) % (P < 0.05), and the rate of puncturing screws were (0 (0–0)) % and (0 (0-6.25)) % (P < 0.05). The median surgical time were 280.0 (IQR: 260.0–300.0) min and 310 (IQR: 267.5–390.0) min in two group and showed significant statistic difference (P < 0.05). Conclusions CASIP has good feasibility and can gain a more accurate and reliable instruments fixation, with which spine surgeons can make a detailed and personalized screw planning preoperatively to achieve satisfying screw placement.

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New neurologic deficit and recovery rates in the treatment of complex pediatric spine deformities exceeding 100 degrees or treated by vertebral column resection (VCR)

Cited by 10 publications

References 14 publications

The prognosis and recovery of major postoperative neurological deficits after corrective surgery for scoliosis

The prognosis and recovery of major postoperative neurological deficits after corrective surgery for scoliosis

Management and surgical outcomes of dystrophic scoliosis in neurofibromatosis type 1: a systematic review

The feasibility and efficacy of computer-assisted screw inserting planning in the surgical treatment for severe spinal deformity: a prospective study

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