Cervical Spinal Cord Injury After Thoracic Spinal Instrumentation

Youlo, Sylvester T.; Merrick, Michael T.; Cassidy, J; Halanski, Matthew A.

doi:10.1097/brs.0000000000000035

Cited by 6 publications

(3 citation statements)

References 11 publications

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“…Similar findings of cervical ischemia after thoracolumbar posterior spinal fusion have been reported previously [6-7]. Some of those cases had an epidural catheter placed.…”

Section: Discussionsupporting

confidence: 87%

“…The most common cause of the deficit was possible ischemic injury at the level of the fusion[5]. In our review of the literature, we found two other papers discussing cervical spinal cord injury ischemia secondary to thoracolumbar fusion [6-7]. We present a similar case to increase the body of literature available about this notable complication in a high-risk population.…”

Section: Introductionmentioning

confidence: 88%

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Cervical Spine Injury Following Thoracic Spinal Fusion for Adolescent Idiopathic Scoliosis

Samtani

Bernatz

Halanski

et al. 2019

Cureus

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Spinal fusion for adolescent idiopathic scoliosis (AIS) can have many potential complications, including spinal cord injury. Most often, spinal cord injury occurs in the region of surgery due to direct mechanical trauma. Vascular compromise in this area may also occur due to a high degree of correction or excessive distraction of the spine. In these cases, the impairment of spinal cord function is often detected intraoperatively with spinal cord monitoring and confirmed in the immediate postoperative period. Injury to the spinal cord above the level of instrumentation is rare.We review the clinical history and outcome of a female adolescent who underwent posterior spinal fusion (PSF) for AIS and developed a cervical spine injury 12 hours postoperatively. The patient is a 13-year old female who underwent PSF for AIS from T1 to L1 for progressive scoliosis measuring over 53 degrees in her right thoracic curve. During surgery, she had modest correction with minimal blood loss and with normal intraoperative motor evoked and somatosensory evoked potentials. The immediate postoperative examination was neurologically intact. Twelve hours later, she developed weakness and tingling in her right upper extremity. Magnetic resonance imaging (MRI) of the cervical spine demonstrated myelomalacia on the right side of the spinal cord at the C5-7 levels.Cervical spine injuries are rare following lower-level fusions, however, these injuries can occur and it is important to be vigilant in monitoring patients for these symptoms. The exact mechanism is unknown and may include a combination of postoperative hypotension with altered vascular anatomy from cord stretch and abnormal cervical positioning.

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“…Similar findings of cervical ischemia after thoracolumbar posterior spinal fusion have been reported previously [6-7]. Some of those cases had an epidural catheter placed.…”

Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 88%

Cervical Spine Injury Following Thoracic Spinal Fusion for Adolescent Idiopathic Scoliosis

Samtani

Bernatz

Halanski

et al. 2019

Cureus

View full text Add to dashboard Cite

show abstract

“…This infrequent complication has been previously described. 12 Similar to what was reported by other authors, [13][14][15][16] the surgical maneuvers most frequently involved were deformity correction with rods, osteotomies, thoracic pedicle screw positioning, and thoracic pedicle wall breach with dural tear. Motor evoked potential changes consisted of MEP disappearance in five of these patients and of a persistent MEP drop of .80% in four others.…”

Section: Discussionsupporting

confidence: 78%

Analysis of Intraoperative Motor Evoked Potential Changes and Surgical Interventions in 513 Pediatric Spine Surgeries

Segura¹,

Talarico²,

Miranda³

et al. 2022

Journal of Clinical Neurophysiology

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Purpose:(1) To determine probabilities of immediate postoperative new motor deficits after no, reversible, and irreversible motor evoked potentials (MEP) deteriorations and (2) to calculate the same outcome considering whether MEP deteriorations were followed by surgical interventions in the absence of confounding factors.Methods: We analyzed MEPs from 513 surgeries. Four-limb MEPs were evoked by transcranial electrical stimulation. Baseline recordings were obtained before skin incision and updated before instrumentation. Motor evoked potentials deteriorations were considered significant whenever they showed a persistent, reversible, or irreversible amplitude decrease of .80% of the baseline values.Results: Nine patients showed postoperative new motor deficits. Probabilities of postoperative new motor deficits were null, 2.8%, and 36.8% with no, reversible, and irreversible MEP deteriorations, respectively. The risk of immediate postoperative new motor deficits was significantly lower (P ¼ 0.0002) in reversible MEP compared with irreversible MEP deteriorations. In patients showing reversible/irreversible MEP deteriorations in the absence of confounding factors, surgical interventions compared with nonsurgical interventions significantly decreased the risk of immediate postoperative new motor deficits (P ¼ 0.0216).Conclusions: This study shows that probabilities of immediate postoperative new motor deficits increase with the severity of intraoperative MEP changes. In addition, our results support the value of surgical interventions triggered by MEP deteriorations to reduce postoperative adverse motor outcomes.

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Delayed postoperative cervical spinal cord ischemic lesion after a thoracolumbar fusion for syndromic scoliosis: a case report and systematic review of the literature

et al. 2021

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Cervical Spinal Cord Injury After Thoracic Spinal Instrumentation

Abstract: Cervical spinal cord injuries may occur after distal deformity correction.

Cited by 6 publications

References 11 publications

Cervical Spine Injury Following Thoracic Spinal Fusion for Adolescent Idiopathic Scoliosis

Cervical Spine Injury Following Thoracic Spinal Fusion for Adolescent Idiopathic Scoliosis

Analysis of Intraoperative Motor Evoked Potential Changes and Surgical Interventions in 513 Pediatric Spine Surgeries

Delayed postoperative cervical spinal cord ischemic lesion after a thoracolumbar fusion for syndromic scoliosis: a case report and systematic review of the literature

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