100. Rates of Neurological Injury Associated with Spine Surgery Based on 108,419 Procedures: A Report of the Scoliosis Research Society Morbidity And Mortality Committee

Hamilton, D. Kojo; Smith, Justin S.; Shaffrey, Christopher I.; Sansur, Charles A.; Berven, Sigurd; Broadstone, Paul A.; Choma, Theodore J.; Goytan, Michael; Noordeen, Hilali; Knapp, Raymond; Hart, Robert A.; Zeller, Reinhard; Donaldson, William F.; Polly, David W.; Perra, Joseph H.; Boachie-Adjei, Oheneba

doi:10.1016/j.spinee.2009.08.124

Cited by 64 publications

(99 citation statements)

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“…In a nationwide study of 10,912 ASD patients, those who underwent revision surgery had a higher rate of procedure-related complications (72 vs. 47 %, p = 0.0001) and increased risk of nervous system injury (odds ratio (OR) = 1.34 [1.10-1.60]) and accidental vessel or nerve puncture (OR = 1.44 [1.29-1.61]) [21•]. This increased risk of neural complications is supported by other studies [22,23] including an SRS review of 108,419 spine surgeries that reported a 41 % higher rate of neural complications after revision compared to primary surgery [24]. However, Hassanzadeh et al [25] compared complications of 167 primary and revision ASD surgeries and did not find a statistically significant increased rate of major complications in the revision group, despite requiring significantly more threecolumn osteotomies (3-COs) than the primary cohort.…”

Section: Revision Surgerymentioning

confidence: 84%

Neurological complications in adult spinal deformity surgery

Iorio

Reid

Kim

2016

Curr Rev Musculoskelet Med

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The number of surgeries performed for adult spinal deformity (ASD) has been increasing due to an aging population, longer life expectancy, and studies supporting an improvement in health-related quality of life scores after operative intervention. However, medical and surgical complication rates remain high, and neurological complications such as spinal cord injury and motor deficits can be especially debilitating to patients. Several independent factors potentially influence the likelihood of neurological complications including surgical approach (anterior, lateral, or posterior), use of osteotomies, thoracic hyperkyphosis, spinal region, patient characteristics, and revision surgery status. The majority of ASD surgeries are performed by a posterior approach to the thoracic and/or lumbar spine, but anterior and lateral approaches are commonly performed and are associated with unique neural complications such as femoral nerve palsy and lumbar plexus injuries. Spinal morphology, such as that of hyperkyphosis, has been reported to be a risk factor for complications in addition to three-column osteotomies, which are often utilized to correct large deformities. Additionally, revision surgeries are common in ASD and these patients are at an increased risk of procedure-related complications and nervous system injury. Patient selection, surgical technique, and use of intraoperative neuromonitoring may reduce the incidence of complications and optimize outcomes.

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Section: Revision Surgerymentioning

confidence: 84%

Neurological complications in adult spinal deformity surgery

Iorio

Reid

Kim

2016

Curr Rev Musculoskelet Med

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“…8,10 There is evidence to support use of IONM during revision spine surgeries, which inherently pose higher risk for neurological injury. 7 In an era when iatrogenic nerve and spinal cord injury are rare, the increased use of IONM during spine surgery could be attributed to a developing culture in surgery that is quick to adopt new technologies, 9,12 thereby increasing medicolegal concerns among spine surgeons, 4 or it could be attributed simply to artifact (increased application of the ICD-9 code for IONM after its introduction in 2007). The variation seen in association with geographic region, urban versus rural settings, and status as a teaching hospital strongly endorses the notion that there is a tangible trend toward increased use, particularly in western states, urban centers, and nonteaching institutions.…”

Section: Discussionmentioning

confidence: 99%

A socioeconomic analysis of intraoperative neurophysiological monitoring during spine surgery: national use, regional variation, and patient outcomes

James

Rughani

Dumont

2014

FOC

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Object In the United States in recent years, a dramatic increase in the use of intraoperative neurophysiological monitoring (IONM) during spine surgeries has been suspected. Myriad reasons have been proposed, but no clear evidence confirming this trend has been available. In this study, the authors investigated the use of IONM during spine surgery, identified patterns of geographic variation, and analyzed the value of IONM for spine surgery cases. Methods In this retrospective analysis, the Nationwide Inpatient Sample was queried for all spine surgeries performed during 2007–2011. Use of IONM (International Classification of Diseases, Ninth Revision, code 00.94) was compared over time and between geographic regions, and its effect on patient independence at discharge and iatrogenic nerve injury was assessed. Results A total of 443,194 spine procedures were identified, of which 85% were elective and 15% were not elective. Use of IONM was recorded for 31,680 cases and increased each calendar year from 1% of all cases in 2007 to 12% of all cases in 2011. Regional use of IONM ranged widely, from 8% of cases in the Northeast to 21% of cases in the West in 2011. Iatrogenic nerve and spinal cord injury were rare; they occurred in less than 1% of patients and did not significantly decrease when IONM was used. Conclusions As costs of spine surgeries continue to rise, it becomes necessary to examine and justify use of different medical technologies, including IONM, during spine surgery.

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“…As all those supportive tools and strategies are burdened with some hazards, they should be applied with care [41][42][43]. The risk of a new neurological deficit (nerve root, cauda equine and spinal cord) after surgery for idiopathic scoliosis during growth is reported to be around 0.7 % according to the most recent report of the Scoliosis Research Society Morbidity and Mortality database [44]. Since the early 1970s until the 1990s the Stagnara wake-up test was the only option for intraoperative detection of surgery-related neurologic deficits.…”

Section: Additional Improvements Over Timementioning

confidence: 99%

A brief overview of 100 years of history of surgical treatment for adolescent idiopathic scoliosis

Hasler

2013

Journal of Children's Orthopaedics

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The history of surgical correction for adolescent idiopathic scoliosis reaches back about 100 years: the natural course of progressive, crippling and sometimes even lifethreatening deformities which could not be controlled by external means called for effectual, invasive procedures. Hibbs 1911 aimed at halting progression by long, uninstrumented fusions. However, the lack of true correction, long rehabilitation times, high pseudarthrosis and infection rates, and a fusion mass which bent further once exposed to gravity again were not satisfying. The transition from slowing progression to halting progression and truly correcting the deformity lasted almost another half a century: Paul Harrington, confronted with many scoliotic polio patients, successfully introduced a hook-rod system for concavedistraction and convex-compression at the end of the 1950s. Many implant failures, a still-considerable pseudarthrosis rate, flattening of the sagittal profile and the lack of true threedimensional (3D) correction were the shortcomings. In the 1970s the Frenchmen Cotrel and Dubousset took scoliosis surgery to the next level by introducing a versatile hook system and curve-pattern-adapted correction modes. The basics of the so-called derotation-manoeuvre consists in strategic distribution of the anchors along the curve, bending the rod accordingly, and rotating it back into the sagittal plane. The overall correction, stability and the fusion rates improved significantly. However, the effect on the sagittal and transverse plane were still limited. Lately, a better biomechanical understanding and bilateral, polysegmental strong three-column fixation with pedicle screw has become the benchmark method: in conjunction with posterior release techniques, osteotomies or even vertebral column resections for severe cases, it allows better 3D control (vertebral column manipulation), faster rehabilitation and better patient satisfaction.

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100. Rates of Neurological Injury Associated with Spine Surgery Based on 108,419 Procedures: A Report of the Scoliosis Research Society Morbidity And Mortality Committee

Cited by 64 publications

References 0 publications

Neurological complications in adult spinal deformity surgery

Neurological complications in adult spinal deformity surgery

A socioeconomic analysis of intraoperative neurophysiological monitoring during spine surgery: national use, regional variation, and patient outcomes

A brief overview of 100 years of history of surgical treatment for adolescent idiopathic scoliosis

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