Responding to Neuromonitoring Changes in 3-Column Posterior Spinal Osteotomies for Rigid Pediatric Spinal Deformities

Jarvis, James; Strantzas, Samuel; Lipkus, Marc; Holmes, Laura; Dear, Taylor; Magana, Sofia; Lebel, David E; Lewis, Stephen J.

doi:10.1097/brs.0b013e3182880378

Cited by 66 publications

(41 citation statements)

References 18 publications

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“…In our clinical experience, the spinal cord can only tolerate approximately 2.5 cm of posterior column shortening over one PVCR level before exhibiting electrophysiologic data changes. Jarvis and colleagues [26] also had similar experiences in which 4 occurrences of data loss that did not react to blood pressure elevation responded to restoration of anterior column height with a cage or less correction.…”

Section: Discussionmentioning

confidence: 72%

“…During corrective rod compression, when data fluctuated, it returned to baseline by quickly addressing subluxation via lessening the compression and/or further decompressing the spinal cord. Jarvis et al [26] studied neuromonitoring changes during three-column osteotomies in 28 patients and reported 23 intraoperative alerts, that is, decrease in SSEP and MEP amplitude by more than 50%. Simply increasing blood pressure improved data 48% of the time.…”

Section: Discussionmentioning

confidence: 98%

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Can Intraoperative Spinal Cord Monitoring Reliably Help Prevent Paraplegia During Posterior Vertebral Column Resection Surgery?

et al. 2015

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 98%

Can Intraoperative Spinal Cord Monitoring Reliably Help Prevent Paraplegia During Posterior Vertebral Column Resection Surgery?

et al. 2015

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“…Because of the critical anatomy with hypoplastic pedicles, and to reduce radiation exposure, the pedicle screw placement is performed using a navigation system [15]. Protection of neural structures and avoidance of neurological deficits during minimally invasive surgery is improved by using intraoperative navigation in conjunction with neuromonitoring [20]. Our patient experienced lower back pain at a young age.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous three column osteotomy for kyphotic deformity correction in congenital kyphosis

et al. 2013

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“…Early spinal resection (with shortening) and correction of the deformity stops the unbalanced growth of the spine and thorax, and results in an overall lengthening of the anterior trunk during growth. As compared with kyphosis correction using distraction techniques [33,34], another advantage of shortening the spine is that it is better tolerated by the spinal cord. In this respect, it is similar to resection of a hemivertebra, another standard spine shortening procedure [35].…”

Section: Discussionmentioning

confidence: 99%

Posterior vertebral column resection in early onset spinal deformities

et al. 2013

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Purpose Early onset spinal deformities (EOSD) can be life-threatening in very young children. In the growing spine, surgical intervention is often unavoidable and should be carried out as soon as possible. A deformed section of the spine not only affects the development of the remaining healthy spine, but also that of the chest wall (which influences pulmonary function), the extremities and body balance. Posterior vertebral column resection (PVCR) represents an effective surgical solution to address such problems. However, reports in the literature concerning PVCR are mostly limited to its use in adolescents or adults. The purpose of this study was to illustrate our experience with PVCR in EOSD and to describe the surgical technique with respect to the unique anatomy of young children. Materials and methods Four children [mean age 3.7 (range 2.5-5.2) years] with severe spinal deformity underwent PVCR through a single approach. Multimodal intraoperative monitoring was used in all cases. Surgery included one stage posterior circumferential resection of one vertebral body along with the adjoining intervertebral discs and removal of all posterior elements. A transpedicular screw-rod system was used for correction and stabilisation. Fusion was strictly limited to the resection site, allowing for later conversion into a growing rod construct at the remaining spine, if necessary. Relevant data were extracted retrospectively from patient charts and long spine radiographs. Results The mean operation time was 500 (range 463-541) min, with an estimated blood loss of 762 (range 600-1,050) ml. Mean follow-up time was 6.3 (range 3.5-12.4) years. After PVCR, the mean Cobb angle for scoliosis was reduced from 69°(range 50-99°) to 29°(5-44°) and the sagittal curvature (kyphosis) from 126°(87-151°) to 61°(47-75°). The mean correction of scoliosis was 57 % (18-92°) and of kyphosis, 51 % (44-62°). There were no spinal cord-related complications. In three patients, spinal instrumentation for growth guidance (fusion less growing rod technique) was applied. Two patients had complications: one patient had a complication of anesthesia, halo pin failure, and revision surgery with extension of the instrumentation cranially due to loss of correction; the second patient had a postoperative infection, which required plastic reconstructive measures. Conclusion PVCR appears to be an effective technique to treat severe EOSD. There are important differences in its use in young children when compared with older patients. In patients with EOSD, additional surgical procedures are often necessary during growth, and hence non-fusion instrumentation beyond the vertebral resection site is advantageous, as it permits spinal growth and the later addition of fusion.

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Responding to Neuromonitoring Changes in 3-Column Posterior Spinal Osteotomies for Rigid Pediatric Spinal Deformities

Cited by 66 publications

References 18 publications

Can Intraoperative Spinal Cord Monitoring Reliably Help Prevent Paraplegia During Posterior Vertebral Column Resection Surgery?

Can Intraoperative Spinal Cord Monitoring Reliably Help Prevent Paraplegia During Posterior Vertebral Column Resection Surgery?

Percutaneous three column osteotomy for kyphotic deformity correction in congenital kyphosis

Posterior vertebral column resection in early onset spinal deformities

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