Incidence and Risk Factors of Neurological Deficits of Surgical Correction for Scoliosis

Qiu, Yong; Wang, Shoufeng; Wang, Bin; Yu, Yang; Zhu, Feng; Zhu, Zezhang

doi:10.1097/brs.0b013e3181657d93

Cited by 102 publications

(57 citation statements)

References 22 publications

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“…New neurological deficits were seen with revision procedures. Qiu et al [13] found that the use of combined procedures, Cobb angle [90°, hyperkyphosis and revision surgery were risk factors for neurological deficits.…”

Section: Neurological Complicationsmentioning

confidence: 99%

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Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years

et al. 2012

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Purpose Our objectives were primarily to review the published literature on complications in neuromuscular scoliosis (NMS) surgery and secondarily, by means of a meta-analysis, to determine the overall pooled rates (PR) of various complications associated with NMS surgery. Methods PubMed and Embase databases were searched for studies reporting the outcomes and complications of NMS surgery, published from 1997 to May 2011. We focused on NMS as defined by the Scoliosis Research Society's classification. We measured the pooled estimate of the overall complication rates (PR) using a random effects meta-analytic model. This model considers both intra-and inter-study variation in calculating PR. Results Systematic review and meta-analysis were performed for 68 cohort and case-control studies with a total of 15,218 NMS patients. Pulmonary complications were the most reported (PR = 22.71 %) followed by implant complications (PR = 12.51 %), infections (PR = 10.91 %), neurological complications (PR = 3.01 %) and pseudoarthrosis (PR = 1.88 %). Revision, removal and extension of implant had highest PR (7.87 %) followed by malplacement of the pedicle screws (4.81 %). Rates of individual studies have moderate to high variability. The studies were heterogeneous in methodology and outcome types, which are plausible explanations for the variability; sensitivity analysis with respect to age at surgery, sample size, publication year and diagnosis could also partly explain this variability. In regard to surgical complications affiliated with various surgical techniques in NMS, the level of evidence of published literature ranges between 2? to 2-; the subsequent recommendations are level C. Conclusion NMS patients have diverse and high complication rates after scoliosis surgery. High PRs of complications warrant more attention from the surgical community. Although the PR of all complications are affected by heterogeneity, they nevertheless provide valuable insights into the impact of methodological settings (sample size), patient characteristics (age at surgery), and continual advances in patient care on complication rates.

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Section: Neurological Complicationsmentioning

confidence: 99%

“…Recently, large database studies on complications of scoliosis surgery have been published [7,9,13,14]. Although these studies benefit from large patient populations, they might be prone to underreporting.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years

et al. 2012

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“…Possible factors associated with higher risk of neurological complications of scoliosis surgery are represented by congenital scoliosis, scoliosis combined with hyperkyphosis, severity of the curve (Cobb angle over 90°), combined approach surgery, revision surgery and decreased spinal cord perfusion due to hypotension and/or significant haemorrhage. Procedures associated with higher risk include vertebral osteotomies and kyphosis correction [1,2]. There exists an urgent need for a method to warn the spine surgeon of impending neurological deficits during surgery.…”

Section: Introductionmentioning

confidence: 99%

The prevention of neural complications in the surgical treatment of scoliosis: the role of the neurophysiological intraoperative monitoring

et al. 2011

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“…3 Factors such as scoliosis with the major curve greater than 90°, hyperkyphosis, congenital scoliosis, combined anterior and posterior surgeries, and multiple surgeries are shown to increase the incidence of neurological events. 2,3,6,13 To prevent these complications, different neuromonitoring modalities have been used during the last 4 decades including monitoring of SSEPs, motor evoked potentials (MEPs), and the wakeup test. Despite the historical success of SSEP and earlier satisfactory results in intraoperative assessment of neurological function, 4,10 its capability to detect the descending motor tract was soon questioned.…”

Section: Discussionmentioning

confidence: 99%

Delayed postoperative neurological complication in a patient with congenital kyphoscoliosis: recovered by revision of the 4-rod instrumentation technique

Javidan

Kabirian²,

Akbarnia³

2013

SPI

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The authors report a case of progressive congenital kyphoscoliosis in which the patient, a boy, originally underwent combined anterior and instrumented posterior spinal fusion at the age of 7 years and 3 months. Early proximal junctional kyphosis and implant failure mandated proximal extension of implants with 2 new rods connected to the old caudad short rods. At the 3-year follow-up, clinical and CT assessment revealed a thoracolumbar pseudarthrosis for which the patient underwent a 2-stage procedure without complication. Recordings of somatosensory evoked potentials intraoperatively were normal. Twelve hours after surgery, his neurological status started to progressively deteriorate. The patient was brought to the operating room, and the initially achieved correction was reversed by an apex-only exposure of the 4-rod system. After surgery the patient started to show progressive improvement in his neurological function. A final myelography was performed and showed free passage of the dye without evidence of obstruction. Clinically, the patient continued to improve and at his 3-month follow-up had near-complete resolution of his neurological deficits. Findings on his physical examination were normal at the final 12-year follow-up. Despite normal findings on intraoperative neuromonitoring, a delayed neurological deficit can occur after complex spine reconstruction. Preoperative risk assessment, surgical approach, and instrumentation deserve careful attention. Advantages of a 4-rod construct are discussed in this case.

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Incidence and Risk Factors of Neurological Deficits of Surgical Correction for Scoliosis

Abstract: In surgical correction of scoliosis, the risk factors for neurologic deficits include CS, scoliosis with hyperkyphosis, scoliosis correction by combined procedures, scoliosis with a Cobb's angle more than 90 degrees , and a revision surgery.

Cited by 102 publications

References 22 publications

Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years

Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years

The prevention of neural complications in the surgical treatment of scoliosis: the role of the neurophysiological intraoperative monitoring

Delayed postoperative neurological complication in a patient with congenital kyphoscoliosis: recovered by revision of the 4-rod instrumentation technique

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