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

Lovi, Alessio; Manfroni, Francesca; Luca, Andrea De; Babbi, Lisa; Brayda-Bruno, Marco

doi:10.1007/s00381-021-05336-z

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…This is the first study reporting the risk of delayed SCI in syndromic and neuromuscular scoliosis, which appears to be almost three times higher than in idiopathic scoliosis. Indications for an increased risk for delayed SCI in syndromic syndromic and neuromuscular scoliosis can also be observed in two recently published case series [15,16]. The case series by Alam et al and Lovi et al report a combined number of 22 cases of delayed SCI in which 64% of patients had a non-idiopathic scoliosis [15,16].…”

Section: Discussionmentioning

confidence: 90%

“…Indications for an increased risk for delayed SCI in syndromic syndromic and neuromuscular scoliosis can also be observed in two recently published case series [15,16]. The case series by Alam et al and Lovi et al report a combined number of 22 cases of delayed SCI in which 64% of patients had a non-idiopathic scoliosis [15,16]. The increased risk of complications in non-idiopathic scoliosis is well known and is mainly caused by underlying comorbidities [3].…”

Section: Discussionmentioning

confidence: 93%

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The risk of delayed spinal cord injury in pediatric spinal deformity surgery

et al. 2022

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Delayed spinal cord injury (SCI) hours or days after surgery, with uneventful monitoring and initial normal postoperative neurological examination, is a rare complication. Based on anecdotal evidence, the risk of delayed spinal cord injury might be higher than previously assumed. Therefore the aim of this study was to determine the risk of delayed SCI after pediatric spinal deformity surgery between 2013-2019 in the Netherlands. The total number of pediatric spinal deformity surgeries performed for scoliosis or kyphosis between 2013-2019 was obtained from the Dutch National Registration of Hospital Care. All eleven Dutch hospitals that perform pediatric spinal deformity surgery were contacted for occurrence of delayed SCI. From the identified patients with delayed SCI, the following data were collected: patient characteristics, details about the SCI, the surgical procedure, management and degree of improvement. 2884 pediatric deformity surgeries were identified between 2013-2019. Seven patients (0.24%) with delayed SCI were reported: 3 idiopathic, 2 neuromuscular (including 1 kypho-scoliosis) and 2 syndromic scoliosis. The risk of delayed SCI after pediatric deformity surgery was 1:595 in idiopathic scoliosis, 1:214 in syndromic scoliosis, 1:201 in neuromuscular scoliosis. All seven patients had a documented normal neurological examination in the first postoperative period; neurological deficits were first diagnosed at a median 16h (range 2.5-40) after surgery. The risk of delayed SCI after pediatric deformity surgery is higher than previously reported, especially in patients with non-idiopathic scoliosis. Regular postoperative testing for late neurologic deficit should be performed for timely diagnosis and management of this devastating complication.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 93%

The risk of delayed spinal cord injury in pediatric spinal deformity surgery

et al. 2022

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“…Perhaps even more disturbing than the intraoperative loss of neuromonitoring data related to spinal cord hypoperfusion are the variety of case reports and small case series describing delayed paralysis in patients with an otherwise successful spinal fusion. Indeed, Welling et al, 14 Kia et al, 15 Quinonez et al, 16 Lovi et al, 17 and Chang et al 18 all describe cases of otherwise routine surgery with delayed neurologic changes from 3 to 60 hours postoperatively. While some authors documented a period of transient hypotension, others demonstrated a significant anemia (i.e., hematocrit of 20%) which may exacerbate an otherwise borderline hypotensive situation.…”

Section: Introductionmentioning

confidence: 99%

“…While some authors documented a period of transient hypotension, others demonstrated a significant anemia (i.e., hematocrit of 20%) which may exacerbate an otherwise borderline hypotensive situation. 17 The majority of these published accounts fortunately resulted in complete neurologic recovery, the authors know of a number of unpublished cases where neurological losses were permanent. Alam et al 19 published an even more concerning series of eight patients with both AIS and neuromuscular spinal deformity with a delayed quadriplegia occurring postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Blood Pressure Management for Patients Undergoing Spinal Fusion for Pediatric Spinal Deformity

Fletcher¹,

Ghag²,

Hedequist³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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Posterior spinal instrumentation and fusion has become the gold standard for definitive management of children and adolescents with spinal deformity. Despite continued innovations designed to improve the safety profile of this complex surgical undertaking, spinal cord injury and resulting loss of neurologic function remain a rare but devastating risk. The increasing power of instrumentation combined with more aggressive correction strategies puts the spinal cord at particular risk due to traction. While the surgeon has the luxury of complex neuromonitoring techniques to alert the team in the presence of a neurologic change during surgery, maintenance of spinal cord perfusion throughout surgery and in the early postoperative period should be considered to avoid spinal cord ischemia as it accommodates to its new position after deformity correction. This manuscript represents recommendations of the POSNA Quality, Value, and Safety spine committee for optimization of blood pressure in the perioperative period.

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