Progressive Myelopathy Patients Who Lack Spinal Cord Monitoring Data Have the Highest Rate of Spinal Cord Deficits Following Posterior Vertebral Column Resection Surgery

Cho, Samuel K.; Lenke, Lawrence G.; Bolon, Shelly M.; Kang, Matthew M.; Zebala, Lukas P.; Pahys, Joshua M.; Cho, Woojin; Koester, Linda A.

doi:10.1016/j.jspd.2014.11.009

Cited by 6 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Spinal cord monitoring is essential to ensure safety of the correction osteotomy during PVCR [ 16 , 36 , 37 ]. Therefore, any preoperative SEP and MEP changes during surgery should be paid attention to.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of neurological complications during posterior vertebral column resection to correct severe post-tubercular kyphosis with late-onset neurological deficits: case series and review of the literature

Hua

Zhang

et al. 2018

J Orthop Surg Res

View full text Add to dashboard Cite

BackgroundSevere post-tubercular kyphosis with late-onset neurological deficits is difficult to treat, with high risk of neurological complications. This study retrospectively evaluates the efficacy and safety of posterior vertebral column resection (PVCR) for treating severe post-tubercular kyphosis with late-onset neurological deficits.MethodsFrom January 2012 to December 2015, 13 patients with severe post-tubercular kyphosis underwent PVCR. All these patients were of late-onset neurological deficits. The operative time, blood loss, preoperative and postoperative kyphotic angles, sagittal vertical axis (SVA), neurological status, and complications were recorded. The preoperative and postoperative Oswestry Disability Index (ODI) scores and visual analog scale (VAS) scores for back pain were compared. The American Spinal Injury Association (ASIA) grading system was used to evaluate neurological function.ResultsThe mean postoperative follow-up period was 28.6 months. The mean operative time was 388 ± 46 min. The mean blood loss was 2554 ± 1459 ml. The mean preoperative and postoperative kyphotic angles were 93.7 ± 14.4° and 31.7 ± 7.3°, respectively, with a mean correction of 62.0 ± 13.8°. The mean preoperative and postoperative SVA were 43.2 ± 44.4 mm and 17.8 ± 16.2 mm, respectively. The mean ODI score improved from 56.3 ± 5.1 preoperatively to 18.3 ± 18.5 at last follow-up. The mean VAS score improved from 6.4 ± 1.8 preoperatively to 1.8 ± 0.8 at last follow-up. Two cases had spinal cord injuries, including one complete paraplegia and one incomplete paraplegia, and a total neurological complication rate of 15.4%. The risk factors for neurological complications were summarized.ConclusionsSevere post-tubercular kyphosis with late-onset neurological deficits can be corrected by PVCR carefully and properly to prevent neurological complications. In many cases with stenosis adjacent to the angular kyphosis, sufficient decompression of the spinal cord at the segments with stenosis is necessary before correcting the kyphosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of neurological complications during posterior vertebral column resection to correct severe post-tubercular kyphosis with late-onset neurological deficits: case series and review of the literature

Hua

Zhang

et al. 2018

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…In It is well known that decreased preoperative neurologic function is significantly associated with postoperative neurologic deficits and intraoperative neuromonitoring data changes, making these patients at high-risk for further worsening of neurologic function. 2,3,9 While the majority of the literature focuses on outcomes in patients with normal preoperative neurologic function or a non-ambulatory, neuromuscular cohort, the "in-between" high-functioning, ambulatory patients with impaired preoperative neurologic status are frequently omitted. 2,3,6,9 Severe pediatric spinal deformity patients often have a substantial component of their deformity in the sagittal plane, which we found to be true in our cohort as well, with the myelopathic patients having a significantly higher rate of kyphoscoliosis diagnoses, as well as larger maximum kyphosis angles and S-DARs compared to the non-myelopathic group preoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,9 While the majority of the literature focuses on outcomes in patients with normal preoperative neurologic function or a non-ambulatory, neuromuscular cohort, the "in-between" high-functioning, ambulatory patients with impaired preoperative neurologic status are frequently omitted. 2,3,6,9 Severe pediatric spinal deformity patients often have a substantial component of their deformity in the sagittal plane, which we found to be true in our cohort as well, with the myelopathic patients having a significantly higher rate of kyphoscoliosis diagnoses, as well as larger maximum kyphosis angles and S-DARs compared to the non-myelopathic group preoperatively. 5,6,13 These results strengthen and align with preexisting theories that sagittal plane angular kyphosis can often cause neurologic impairment due to the increased compression and/or stretch placed on the spinal cord as it passed the sharp bony bend.…”

Section: Discussionmentioning

confidence: 99%

“…14 While we know that surgical treatment for myelopathic patients is associated with higher risks of intra-and postoperative complications, surgical intervention is necessary to first and foremost, decompress the spinal cord, and second, correct the deformity as safely as possible. 2,8,9,14 Techniques to treat severe spinal deformity and subsequent spinal cord stretch/ compression can entail preoperative HGT, use of complex osteotomies (i.e. VCR), spinal instrumentation and fusion, and/or multiple staged surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3]6 Patient characteristics such as larger coronal and sagittal Cobb angles, rigid deformities, high deformity angular ratios (DAR), and abnormal spinal cord morphology are risk factors for intraoperative neuromonitoring data changes and/or loss. 2,3,6,[8][9][10] In addition to these risk factors, the presence of preoperative neurologic deficits can significantly increase the odds of postoperative complications. 3,6 Though many pediatric patients with severe deformity requiring spinal reconstruction have a neuromuscular condition and utilize a wheelchair for mobility, ambulators represent a starkly different cohort.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Myelopathic Patients Undergoing Severe Pediatric Spinal Deformity Surgery Can Improve Neurologic Function to That of Non-Myelopathic Patients by 1-Year Postoperative

Cerpa

Zuckerman

Lenke

et al. 2021

Global Spine Journal

Self Cite

View full text Add to dashboard Cite

Study Design: Multi-center, prospective, observational cohort. Objective: To compare myelopathic vs. non-myelopathic ambulatory patients in short- and long-term neurologic function, operative treatment, and patient-reported outcomes. Methods: Pediatric deformity patients from 16 centers were enrolled with the following inclusion criteria: aged 10-21 years-old, a Cobb angle ≥100° in either the coronal or sagittal plane or any sized deformity with a planned 3-column osteotomy, and community ambulators. Patients were dichotomized into 2 groups: myelopathic (abnormal preoperative neurologic exam with signs/symptoms of myelopathy) and non-myelopathic (no clinical signs/symptoms of myelopathy). Results: Of 311 patients with an average age of 14.7 ± 2.8 years, 29 (9.3%) were myelopathic and 282 (90.7%) were non-myelopathic. There was no difference in age ( P = 0.18), gender ( P = 0.09), and Risser Stage ( P = 0.06), while more patients in the non-myelopathic group had previous surgery (16.1% vs. 3.9%; P = 0.03). Mean lower extremity motor score (LEMS) in myelopathic patients increased significantly compared to baseline at every postoperative visit: Baseline: 40.7 ± 9.9; Immediate postop: 46.0 ± 7.1, P = 0.02; 1-year: 48.2 ± 3.7, P < 0.001; 2-year: 48.2 ± 7.7, P < 0.001). The non-myelopathic group had significantly higher LEMS immediately postoperative ( P = 0.0007), but by 1-year postoperative, there was no difference in LEMS between groups (non-myelopathic: 49.3 ± 3.6, myelopathic: 48.2 ± 3.7, P = 0.10) and was maintained at 2-years postoperative (non-myelopathic: 49.2 ± 3.3, myelopathic: 48.2 ± 5.7, P = 0.09). Both groups improved significantly in all SRS domains compared to preoperative, with no difference in scores in the domains for pain ( P = 0.12), self-image ( P = 0.08), and satisfaction ( P = 0.83) at latest follow-up. Conclusion: In severe spinal deformity pediatric patients presenting with preoperative myelopathy undergoing spinal reconstructive surgery, myelopathic patients can expect significant improvement in neurologic function postoperatively. At 1-year and 2-year postoperative, neurologic function was no different between groups. While non-myelopathic patients had significantly higher postoperative outcomes in SRS mental-health, function, and total-score, both groups had significantly improved outcomes in every SRS domain compared to preoperative.

show abstract

Establishing consensus: determinants of high-risk and preventative strategies for neurological events in complex spinal deformity surgery

et al. 2022

View full text Add to dashboard Cite

Progressive Myelopathy Patients Who Lack Spinal Cord Monitoring Data Have the Highest Rate of Spinal Cord Deficits Following Posterior Vertebral Column Resection Surgery

Cited by 6 publications

References 23 publications

Incidence and risk factors of neurological complications during posterior vertebral column resection to correct severe post-tubercular kyphosis with late-onset neurological deficits: case series and review of the literature

Incidence and risk factors of neurological complications during posterior vertebral column resection to correct severe post-tubercular kyphosis with late-onset neurological deficits: case series and review of the literature

Myelopathic Patients Undergoing Severe Pediatric Spinal Deformity Surgery Can Improve Neurologic Function to That of Non-Myelopathic Patients by 1-Year Postoperative

Establishing consensus: determinants of high-risk and preventative strategies for neurological events in complex spinal deformity surgery

Contact Info

Product

Resources

About