Iatrogenic paraplegia in spinal surgery

Delank, Karl‐Stefan; Delank, H. W.; König, D. P.; Popken, F.; Fürderer, S.; Eysel, Peer

doi:10.1007/s00402-004-0763-5

Cited by 48 publications

(29 citation statements)

References 21 publications

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“…The PSF-H group (n = 27 patients) consisted of 23 female and 4 male patients, with a mean age at surgery of 14.9 years (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and a mean Risser's sign of 2.34 (0-5). The curve patterns according to the Lenke's classification were 11 (40%) type 1, 9 (33.3%) type 2, 3 (11%) type 3, and 4 (15%) type 4.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, the risks of a too aggressive posterior-only correction not preceded by an anterior release should not be underestimated. Overdistraction should be avoided due to the risk of spinal cord ischemia [17]. In the past, it was reported that an intraoperative correction exceeding the preoperative bending correction was one of the factors related to an increased risk of spinal cord injury [58].…”

Section: Discussionmentioning

confidence: 99%

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Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

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The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80°traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5-8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic ([80°) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80°(Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF-H group; n = 27 patients), or with pedicle screw-only construct (PSF-S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser's sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF-H: 92°vs. PSF-S: 88°), or flexibility on bending films (PSF-H: 27% vs. PSF-S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for nonparametric paired analysis, and the Mann-Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF-S group, when compared to the PSF-H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of -1.9°versus -11.3°( P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (-1.00 vs. -0.54 cm; P = 0.04), and tilt (-19°vs. -10°; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF-H = 0.5 cm vs. PSF-S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

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“…Another long series compiled by Delank et al 28 includes an incidence of iatrogenia in scoliosis surgery of 0.55%. In our study, the incidence of SCI following scoliosis was one case, but we could not find the incidence as the patient was referred from another hospital and we do not know the total number of scoliosis interventions that were carried out.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic spinal cord injury: an observational study

et al. 2011

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Study design: Retrospective descriptive observational study. Objective: The primary objective of this study was to quantify the incidence of iatrogenic spinal cord injury (SCI) at our SCI unit (SCIU). The secondary objective was to discover the surgical and medical procedures that cause iatrogenic SCI and to estimate the incidence with each procedure. Subjects: Patients admitted to or seen at outpatient services of the SCIU at a university hospital. Methods: Histories were compiled from 1 July 2005 to 30 June 2009. We included patients with SCI caused by any medical or surgical procedure. We collected age, sex, diagnosis leading to medical intervention, predominant clinical manifestations, medical-surgical procedure and level and grade of injury upon admission and discharge. Results: Out of 250 patients admitted to the SCIU, 32 (14.7%) patients presented iatrogenic SCI. Average age was 56.2 (s.d. 17.3), ranging from 0 to 82 years old. The most frequent clinical manifestation was pain. The most common diagnosis was channel stenosis. Lumbar level grade C of American Spine Injury Association (ASIA) was the most frequently observed. Conclusion: The rise in the population's life expectancy entails an increase in elderly patients with vascular risk factors, who underwent invasive interventions leading to spinal cord iatrogenia.

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“…However, the limitation of such procedure is well known and particularly such a test provides information regarding the motor function only. Nevertheless the recent study in major German spine centres [2] document that 63% of patients undergoing surgery for correction of scoliosis are still using the Stagnara Wake-up test as a means of monitoring of the surgical procedure. The electrophysiological monitoring by means of SEP was performed in 18% and the motor evoked potentials by transcranial cortex stimulation were done in Germany only in 9% of the cases (study published in 2005).…”

Section: Discussionmentioning

confidence: 99%

“…A recent study in Germany [2] reviewed retrospectively 1,194 patients in one spine centre being operated over the period of 10 years with spinal fusion and observed that seven patients (0.59%) experienced post surgical complete or incomplete paraplegia. The same group performed an additional survey within 17 German University Clinics and designated centres for spinal surgery and surveyed 3,115 scoliosis surgeries with a frequency of iatrogenic paraplegia of 0.55%.…”

Section: Introductionmentioning

confidence: 99%

Multimodal intraoperative monitoring during surgery of spinal deformities in 217 patients

et al. 2007

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A prospective study was performed on 217 patients who received MIOM during corrective surgery of spinal deformities between March 2000 and December 2005. Aim is to determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve root function during corrective spine surgery. MIOM is becoming an increasingly used method of monitoring function during corrective spine surgery. The combination of monitoring of ascending and descending pathways may provide more sensitive and specific results giving immediate feedback information regarding any neurological deficits during the operation. Intraoperative somatosensory spinal and cerebral evoked potentials combined with continuous EMG and motor evoked potentials of the spinal cord and muscles were evaluated and compared with postoperative clinical neurological changes. A total of 217 consecutive patients with spinal deformities of different aetiologies were monitored by means of MIOM during the surgical procedure. Out of which 201 patients presented true negative findings while one patient presented false negative and three patients presented false positive findings. Twelve patients presented true positive findings where neurological deficit after the operation was predicted. All neurological deficits in those 12 patients recovered completely. The sensitivity of MIOM applied during surgery of spinal deformities has been calculated of 92.3% and the specificity 98.5%. Based upon the results of this study MIOM is an effective method of monitoring the spinal cord and nerve root function during corrective surgery of spinal deformities and consequently improves postoperative results. The Wake-up test for surgical procedure of spinal deformities became obsolete in our institution.

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Iatrogenic paraplegia in spinal surgery

Abstract: Operative treatment of scoliosis with a high degree of correction carries a risk of neurological complications of about 0.5%. Mechanical as well as ischaemic damage to the spinal cord can be detected early by means of consistent intraoperative neuromonitoring.

Cited by 48 publications

References 21 publications

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Iatrogenic spinal cord injury: an observational study

Multimodal intraoperative monitoring during surgery of spinal deformities in 217 patients

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