Spinal Shortening in Scoliosis Surgery. A Case With Transitory Paraplegia

Pedrals, José Grass

doi:10.1097/01241398-199705000-00052

Cited by 3 publications

(3 citation statements)

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“…1,3 Procedures that shorten or especially those that lengthen the vertebral column also carry significant risk. 1,48 Both anterior and posterior spinal surgeries and ligation of segmental vessels are thought to lead to violation of spinal cord blood supply, although the latter had produced no major problem in 1 center. 49 Severe kyphosis is associated with a higher incidence of neurologic deficit, even without surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Hypotension-Induced Loss of Intraoperative Monitoring Data During Surgical Correction of Scheuermann Kyphosis: A Case Report

Othman¹,

Lenke²,

Bolon³

et al. 2004

Spine

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Although a state of mild hypotension may be beneficial to limit blood loss during spinal deformity corrective surgery, acute and/or prolonged hypotension may jeopardize spinal cord vascularity and should be avoided especially during surgical treatment of high-risk deformities such as kyphosis. Early warning by multimodality physiologic neuromonitoring appears to be a useful method to alert surgeons of the potentially devastating problem of hypotension-induced spinal cord dysfunction and allows immediate corrective actions.

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Section: Discussionmentioning

confidence: 99%

Hypotension-Induced Loss of Intraoperative Monitoring Data During Surgical Correction of Scheuermann Kyphosis: A Case Report

Othman¹,

Lenke²,

Bolon³

et al. 2004

Spine

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“…A abordagem cirúrgica de deformidades rígidas requer cuidados especiais, pois muitos autores indicam que esse é um fator de risco para o desenvolvimento da paraplegia 2-4, 18, 20, 22 . Tais medidas incluem a tração halofemoral no período pré-operatório e a abordagem por via anterior, realizando a discectomia no ápice da curva e em alguns casos até a ressecção do corpo vertebral, conforme relatado por Pedrals 23 .…”

Section: Resultsunclassified

Comparação entre o teste de despertar e a monitoração neurofisiológica intra-operatória com potencial evocado somato-sensitivo nas cirurgias de escoliose

et al. 2009

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OBJETIVO: comparar a incidência de lesões neurológicas em cirurgias corretivas de curvas rígidas de escoliose idiopática, utilizando-se somente o teste do despertar e utilizando-se a monitoração neurofisiológica intra-operatória por meio dos Potenciais Evocados Somato-Sensitivo (PESS). MÉTODOS: foram realizadas 111 cirurgias para correção de escoliose idiopática, com curvas rígidas por meio de instrumentação e artrodese pela via posterior, no período de janeiro de 1985 a maio de 2001. Os procedimentos foram divididos em dois grupos, sendo 80 pacientes operados sem a monitoração intra-operatória, utilizando somente o teste do despertar, no período de janeiro de 1985 a janeiro de 1998. A partir de maio de 1998, as cirurgias passaram a ser monitoradas com potencial evocado somato-sensitivo (PESS), para prevenção de lesão neurológica, formando um segundo grupo de 31 pacientes. RESULTADOS: no primeiro grupo, um paciente teve lesão neurológica irreversível e quatro pacientes tiveram lesão neurológica reversível. Entre os 31 pacientes do segundo grupo, com monitoração neurofisiológica sensitiva durante a cirurgia, oito apresentaram lesão neurológica reversível constatada no intra-operatório, sem nenhuma repercussão clínica após o procedimento. CONCLUSÃO: os resultados apresentados sugerem a eficácia da monitoração intra-operatória, com o potencial evocado somato-sensitivo, para a prevenção de lesões neurológicas, nas cirurgias corretivas de curvas rígidas na escoliose idiopática.

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“…[1][2][3] In this process, spinal shortening is a basic and commonly performed operation for the correction of spinal deformity and the fusion of osteotomy surface. 2,4,5 However, there exists the risk of neurologic complications induced by spinal cord injury (SCI) due to overshortened spinal cord. 2 These complications can be catastrophic for the patients and are very costly.…”

Section: Introductionmentioning

confidence: 99%

Study on the safe range of shortening of the spinal cord in canine models

et al. 2012

Spinal Cord

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Study design: Experimental dog model of spinal cord shortening. Objectives: To clarify the relationship between the amount of shortening of the spinal cord and the degree of injury it may induce, and to determine the safe range of the shortening. Setting: Xi'an Jiaotong University, China. Methods: Thirty adult dogs were randomly allocated to five groups. Dogs in Group A (sham operation control) underwent spondylectomy to have two-thirds of the thirteenth thoracic segment (T13) resected, without bone-to-bone contact of the adjacent vertebral bodies. Those in Group B, C, D and E had one-third, half, two-thirds and total of their T13 resected, respectively, with boneto-bone contact. Somatosensory-evoked potentials (SEP) and spinal cord blood flow (SCBF) were detected. The histopathologic changes of spinal cord tissue were observed by hematoxylin and eosin stain and electron microscope. Results: The shortening of the spinal cord o half of a vertebral segment height caused a reversible change of SEP. Whereas, the changes resulted from the shortening of more than two-thirds of a vertebral segment height did not return to the normal level. SCBF increased temporarily when the shortening was within two-thirds of a vertebral segment height; whereas, it decreased progressively when the length of the shortening was equal to one vertebral segment height. More serious hemorrhage occurred as the shortening increased. INTRODUCTIONVertebrectomy is commonly performed in treating spinal deformity, tumors of the spinal column and other abnormal spinal conditions. [1][2][3] In this process, spinal shortening is a basic and commonly performed operation for the correction of spinal deformity and the fusion of osteotomy surface. 2,4,5 However, there exists the risk of neurologic complications induced by spinal cord injury (SCI) due to overshortened spinal cord. 2 These complications can be catastrophic for the patients and are very costly. Therefore, it is of great importance to clarify the pathophysiological changes of spinal cord shortening and determine the safe range of the shortening so as to prevent SCI.However, the safe range of shortening of the spinal column is still in debate. Two previous studies recognized the association between SCI and the range of spinal column shortening, but reached different conclusions in the safe range. 6,7 It seems that further research is necessary to confirm the safe shortening range. Besides, we have found no report about the serial changes of somatosensory-evoked potentials (SEP) and spinal cord blood flow (SCBF) over time with different amount of spinal shortening. The present study was therefore conducted, in which a modified animal model was used and detailed variations of SCBF and SEP were quantitatively recorded over a longer period of time at each stage of shortening. The obtained

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Spinal Shortening in Scoliosis Surgery. A Case With Transitory Paraplegia

Cited by 3 publications

References 0 publications

Hypotension-Induced Loss of Intraoperative Monitoring Data During Surgical Correction of Scheuermann Kyphosis: A Case Report

Hypotension-Induced Loss of Intraoperative Monitoring Data During Surgical Correction of Scheuermann Kyphosis: A Case Report

Comparação entre o teste de despertar e a monitoração neurofisiológica intra-operatória com potencial evocado somato-sensitivo nas cirurgias de escoliose

Study on the safe range of shortening of the spinal cord in canine models

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