Risk factors for neurological complications in severe and rigid spinal deformity correction of 177 cases

Abstract

Background Difficult procedures of severe rigid spinal deformity increase the risk of intraoperative neurological injury. Here, we aimed to investigate the preoperative and intraoperative risk factors for postoperative neurological complications when treating severe rigid spinal deformity. Methods One hundred seventy-seven consecutive patients who underwent severe rigid spinal deformity correction were assigned into 2 groups: the neurological complication (NC, 22 cases) group or non-NC group (155 cases). The baseline demographics, preoperative spinal cord functional classification, radiographic parameters (curve type, curve magnitude, and coronal/sagittal/total deformity angular ratio [C/S/T-DAR]), and surgical variables (correction rate, osteotomy type, location, shortening distance of the osteotomy gap, and anterior column support) were analyzed to determine the risk factors for postoperative neurological complications. Results Fifty-eight patients (32.8%) had intraoperative evoked potentials (EP) events. Twenty-two cases (12.4%) developed postoperative neurological complications. Age and etiology were closely related to postoperative neurological complications. The spinal cord functional classification analysis showed a lower proportion of type A, and a higher proportion of type C in the NC group. The NC group had a larger preoperative scoliosis angle, kyphosis angle, S-DAR, T-DAR, and kyphosis correction rate than the non-NC group. The results showed that the NC group tended to undergo high-grade osteotomy. No significant differences were observed in shortening distance or anterior column support of the osteotomy area between the two groups. Conclusions Postoperative neurological complications were closely related to preoperative age, etiology, severity of deformity, angulation rate, spinal cord function classification, intraoperative osteotomy site, osteotomy type, and kyphosis correction rate. Identification of these risk factors and relative development of surgical techniques will help to minimize neural injuries and manage postoperative neurological complications.

Sequential correction of severe and rigid kyphoscoliosis: a new technical note and preliminary results

“…Severe and rigid kyphoscoliosis may affect the thoracic cage, disturbing skeletal, muscular, and diaphragmatic functions, and reducing respiratory system compliance [ 12 ]. Patients with severe and rigid kyphoscoliosis may experience restrictive pulmonary and cardiovascular diseases and malnutrition, leading to physical disability or death [ 12 , 13 ]. Hence, early surgical treatment is recommended to improve pulmonary function and increase life expectancy [ 12 , 14 ].…”

Sequential correction using satellite rod for the treatment of severe rigid spinal deformity: a retrospective study of 19 cases

“…Spine is completely separated into two sections because of three-column vertebral osteotomy during PVCR. Due to the complex spinal structure of patients with severe rigid spinal deformity, complexity of PVCR and difficult screw placement remarkably increase the risk of operative time, blood loss, neurological injury, and potential morbidity [ 22 ]. According to the literatures, the overall complication rate of PVCR is 69.2% (range from 23.8% to 100%) [ 23 ].…”

“…Postoperative neurological complications are closely related to preoperative age, etiology, severity of deformity, angulation rate, spinal cord function classification, intraoperative osteotomy site, osteotomy type, and kyphosis correction rate [ 22 ]. Pre-existing neurologic dysfunction is believed to be independent risk factors for neurologic deficits during PVCR procedure [ 25 ].…”

Sequential Correction Using Satellite Rod for the Treatment of Severe Rigid Spinal Deformity: A Retrospective Study of 19 Cases

“…Spine is completely separated into 2 sections because of 3-column vertebral osteotomy. Due to the complex spinal structure of patients with severe rigid spinal deformity, complexity of PVCR and di cult screw placement remarkably increase the risk of operative time, blood loss, neurological injury, and potential morbidity [17] . According to the literatures, the overall complication rate of PVCR is 69.2% (range from 23.8% to 100%) [18] .…”

“…Postoperative neurological complications were closely related to preoperative age, etiology, severity of deformity, angulation rate, spinal cord function classi cation, intraoperative osteotomy site, osteotomy type, and kyphosis correction rate [17] . Preexisting neurologic dysfunction is believed to be independent risk factors for neurologic de cits during PVCR procedure [20] .…”