Delayed Postoperative Neurologic Deficits in Spinal Deformity Surgery

Auerbach, Joshua D.; Kean, Kristin E.; Milby, Andrew H.; Paonessa, Kenneth J.; Dormans, John P.; Newton, Peter O.; Song, Kit M.; Lonner, Baron S.

doi:10.1097/brs.0000000000001194

Cited by 34 publications

(22 citation statements)

References 15 publications

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“…In a recently reported series of patients with DPND, 90% occurred within the first 48 hours; the majority had complete or partial recovery while up to a third had no recovery [5]. It is important to note that, in this series, compression-related DPND had a greater likelihood of experiencing some neurological recovery as compared to ischemia-related DPND.…”

Section: Discussionmentioning

confidence: 72%

“…Unfortunately, neuromonitoring techniques are rarely extended beyond the operating room and thus it is difficult to detect neurological complications that present in a delayed fashion. In a recent meta-analysis, delayed postoperative neurological deficits (DPND) were identified in .01% of cases [5]. The most common cause of the deficit was possible ischemic injury at the level of the fusion[5].…”

Section: Introductionmentioning

confidence: 99%

“…In a recent meta-analysis, delayed postoperative neurological deficits (DPND) were identified in .01% of cases [5]. 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].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…This phenomenon is known as spinal cord ischaemia‐reperfusion injury (SCIRI), a common and serious secondary injury observed clinically. Spinal cord ischaemia‐reperfusion injury often occurs after surgery of the spine, spinal cord and thoracoabdominal aorta . It has characteristics including disability, high mortality and poor prognosis and is a clinical problem that urgently needs to be solved.…”

Section: Introductionmentioning

confidence: 99%

“…Spinal cord ischaemia-reperfusion injury often occurs after surgery of the spine, spinal cord and thoracoabdominal aorta. 1,2 It has characteristics including disability, high mortality and poor prognosis and is a clinical problem that urgently needs to be solved. The pathogenesis of SCIRI is complex, and the specific mechanism of spinal cord death in response to reperfusion is not clear.…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine attenuates neuronal injury after spinal cord ischaemia‐reperfusion injury by targeting the CNPY2‐endoplasmic reticulum stress signalling

Zhao

Zhai

et al. 2019

J Cellular Molecular Medi

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Dexmedetomidine (Dex) has been proven to exert protective effects on multiple organs in response to ischaemia‐reperfusion injury, but the specific mechanism by which this occurs has not been fully elucidated. The purpose of this study was to investigate whether Dex attenuates spinal cord ischaemia‐reperfusion injury (SCIRI) by inhibiting endoplasmic reticulum stress (ERS). Our team established a model of SCIRI and utilized the endoplasmic reticulum agonist thapsigargin. Dex (25 g/kg) was intraperitoneally injected 30 minutes before spinal cord ischaemia. After 45 minutes of ischaemia, the spinal cord was reperfused for 24 hours. To evaluate the neuroprotective effect of Dex on SCIRI, neurological function scores were assessed in rats and apoptosis of spinal cord cells was determined by TUNEL staining. To determine whether the endoplasmic reticulum apoptosis pathway CNPY2‐PERK was involved in the neuroprotective mechanism of Dex, the expression levels of related proteins (CNPY2, GRP78, PERK, CHOP, caspase‐12, caspase‐9 and caspase‐3) were detected by western blot analysis and RT‐PCR. We observed that Dex significantly increased the neurological function scores after SCIRI and decreased apoptosis of spinal cord cells. The expression of ERS‐related apoptosis proteins was significantly increased by SCIRI but was significantly decreased in response to Dex administration. Taken together, the results of this study indicate that Dex may attenuate SCIRI by inhibiting the CNPY2‐ERS apoptotic pathway.

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Anesthesia for Pediatric Spinal Deformity

McLeod

2022

Multidisciplinary Spine Care

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Delayed Postoperative Neurologic Deficits in Spinal Deformity Surgery

Abstract: 4.

Cited by 34 publications

References 15 publications

Cervical Spine Injury Following Thoracic Spinal Fusion for Adolescent Idiopathic Scoliosis

Cervical Spine Injury Following Thoracic Spinal Fusion for Adolescent Idiopathic Scoliosis

Dexmedetomidine attenuates neuronal injury after spinal cord ischaemia‐reperfusion injury by targeting the CNPY2‐endoplasmic reticulum stress signalling

Anesthesia for Pediatric Spinal Deformity

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