Neurological complications in adult spinal deformity surgery

Abstract

The number of surgeries performed for adult spinal deformity (ASD) has been increasing due to an aging population, longer life expectancy, and studies supporting an improvement in health-related quality of life scores after operative intervention. However, medical and surgical complication rates remain high, and neurological complications such as spinal cord injury and motor deficits can be especially debilitating to patients. Several independent factors potentially influence the likelihood of neurological complications including surgical approach (anterior, lateral, or posterior), use of osteotomies, thoracic hyperkyphosis, spinal region, patient characteristics, and revision surgery status. The majority of ASD surgeries are performed by a posterior approach to the thoracic and/or lumbar spine, but anterior and lateral approaches are commonly performed and are associated with unique neural complications such as femoral nerve palsy and lumbar plexus injuries. Spinal morphology, such as that of hyperkyphosis, has been reported to be a risk factor for complications in addition to three-column osteotomies, which are often utilized to correct large deformities. Additionally, revision surgeries are common in ASD and these patients are at an increased risk of procedure-related complications and nervous system injury. Patient selection, surgical technique, and use of intraoperative neuromonitoring may reduce the incidence of complications and optimize outcomes.

Age-related reduction of trunk muscle torque and prevalence of trunk sarcopenia in community-dwelling elderly: Validity of a portable trunk muscle torque measurement instrument and its application to a large sample cohort study

“…Furthermore, the number of spine surgeries in older people is increasing in “super-aged” societies where more than 20% of the population is 65 years or older [ 11 ]. There have been reports that wounds caused by invasive surgery cause numerous complications that lead to unsatisfactory outcomes [ 12 ].…”

Predictors for Non-Home Patient Discharge Following Elective Adult Spinal Deformity Surgery

“…2,3 However, postoperative complication and revision rates remain high. 2,4 In fact, the United States Bone and Joint Initiative estimates nearly $50 billion in hospital discharge costs associated with ASD. 5 Advances in surgical and anesthetic techniques have made the option of ASD surgery available to a greater portion of the elderly population, a growing demographic in the United States.…”

Loss of intraoperative neurological monitoring signals during flexed prone positioning on a hinged open frame during surgery for kyphoscoliosis correction: case report

“…13 Risk factors for neurological injuries in spinal deformity surgery include magnitude of curvature correction, use of three-column osteotomies, revision surgery, and hyperkyphosis, particularly in the thoracic spine. 9,11,16 As such, our patient's focal kyphotic deformity with severe stenosis likely increased his risk of a neurological complication. Given the patient's more recent bilateral lower-extremity symptoms, one could argue that the compression from his kyphosis was beginning to reach a critical point and even the slight exacerbation from flexion of the hinged bedframe was enough to cause further deficit.…”