Neurological complications of thoracic posterior vertebral column resection for severe congenital spinal deformities

Bobo, Zhang; Tao, Zhang; Huang, Tao; Wu, Ten-Ming; Duan, Chunguang; Yang, Wenjun; Li, Tao; Li, Feng; Liu, Ming; Ma, Wenrui; Wei, Su

doi:10.1007/s00586-017-5061-3

Cited by 23 publications

(41 citation statements)

References 21 publications

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“…Previous investigators reported that the incidence of neurological problem was from 1.2% to 17.1%. [ 8 , 20 – 23 ] In our series, the neurological complication occurred only in group 1, which followed unexpected additional operation in all of the cases. In group 1, the additional operation was significantly more than group 2 (13 and 3 cases, P = .007).…”

Section: Discussionmentioning

confidence: 53%

Surgical and radiological outcomes after posterior vertebral column resection according to the surgeon's experience

et al. 2018

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The purpose of this study was to estimate and analyze the radiological, surgical, and clinical results of posterior vertebral column resection (PVCR) according to the surgeon's experience. Although PVCR has been recognized as the most powerful surgical technique to correct severe spinal deformity, PVCR is a technically demanding procedure with a high complication rate. A retrospective review of the chart and radiographic data of 34 consecutive patients who received PVCR was carried out. According to the time period, the former and latter 17 patients were divided into group 1 and group 2, respectively. Patients’ demographics, surgical, radiological/clinical outcomes, and complications were compared between the groups. The demographic data of the patients had no significant difference between the groups. The surgical time (492.5 ± 164.8 vs 350.5 ± 133.9 minutes, P = .010), estimated blood loss (1294.1 ± 711.9 vs 974.1 ± 905.9 mL, P = .045), and length of hospital stay (22.8 ± 12.9 vs 13.4 ± 3.9 days, P = .017) were significantly reduced in group 2. The correction of the PVCR site (40.5° ± 13.3° vs 41.2° ± 23.7°, P = .909), sagittal vertical axis (SVA, 81.9 ± 7.2 mm vs 77.9 ± 102.0 mm, P = .904) were not different between the groups. The total number of complications (22 vs 10, P = .031) and patients having complications (13 vs 7, P = .039) were lower in group 2. Additional surgery was significantly lower in group 2 (13 vs 3, P = .007). The clinical outcomes by revised Scoliosis Research Society-22 (SRS-22r) questionnaire were not different between the groups. Our series revealed that the complications after PVCR may reduce from 17 cases and surgical outcomes might be stabilized by 29 cases.

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Section: Discussionmentioning

confidence: 53%

Surgical and radiological outcomes after posterior vertebral column resection according to the surgeon's experience

et al. 2018

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“…CS is one of the most difficult type of early onset scoliosis to manage. This congenital vertebral defect can lead to significant spine deformities, which occasionally present as rigid, severe curvature requiring osteotomy (e.g., SPO, PSO or VCR) to obtain global balance of the spine [ 9 – 11 ]. CS is also often associated with anomalies in other organs, which may be isolated or in association with the VACTERL (vertebral anomalies, anorectal atresia, cardiac anomalies, tracheoesophageal fistula, esophageal atresia, renal and limb anomalies) syndrome [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Postoperative pulmonary complications following posterior spinal instrumentation and fusion for congenital scoliosis

Yin

Huang

et al. 2018

PLoS ONE

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BackgroundCongenital scoliosis (CS) may lead to more serious pulmonary complications compared with idiopathic scoliosis after spinal fusion surgery. However, little has been reported about postoperative pulmonary complication events in patients with CS after spinal fusion surgery.ObjectiveTo investigate the incidence of and predictive factors of postoperative pulmonary complications following posterior spinal instrumentation and fusion surgery for the treatment of CS.MethodsWe retrospectively reviewed the records of 174 patients with CS (128 females and 46 males, mean age 16.4 years) treated with posterior spinal instrumentation and fusion surgery between January 2012 and April 2017. We extracted demographic, medical history, and clinical data, and investigated the major predictive factors for postoperative pulmonary complications by logistic regression and receiver-operating characteristic curves analyses.ResultsA total of 26 (14.9%) patients developed postoperative pulmonary complications, consisting of pleural effusion (10.9%), pneumonia (6.9%), pneumothorax (1.1%), atelectasis (2.3%), hypoxemia (6.3%), and respiratory failure (1.1%). Logistic regression analysis revealed that the predictive factors for postoperative pulmonary complications were age > 18.1 years (P = 0.039), a Cobb angle of > 77° (P = 0.011), operation time of > 430 min (P = 0.032), and blood transfusion volume > 1500 ml (P = 0.015).ConclusionsPostoperative pulmonary complications are among the main complications following posterior spinal instrumentation and fusion surgery in patients with CS. Such patients aged >18.1 years, with Cobb angles > 77°, operation times > 430 min, and/or blood transfusion volume of > 1500 ml may be more likely to develop postoperative pulmonary complications.

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“…PVCR is a surgically demanding technique with a high complication rate (40–67%) after surgery [ 6 , 10 , 25 ]. Neurologic complications are reported in 1.2–17.1% of patients [ 5 , 15 , 20 , 26 ]. Because of these problems, surgeons should evaluate the risks and share the information with patients or their guardians before surgery.…”

Section: Discussionmentioning

confidence: 99%

Total Deformity Angular Ratio as a Risk Factor for Complications after Posterior Vertebral Column Resection Surgery

Lee

Hyun

Han

et al. 2018

J Korean Neurosurg Soc

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ObjectiveThe aim of the present study was to identify whether the deformity angular ratio (DAR) influences the occurrence of complications after posterior vertebral column resection (PVCR) and to establish the DAR cut-off value. MethodsThirty-six consecutive patients undergoing PVCR from December 2010 to October 2016 were reviewed. The relationships between the total, sagittal, and coronal DAR and complications were assessed using receiver operator characteristics curves. The patients were divided into two groups according to a reference value based on the cut-off value of DAR. Demographic, surgical, radiological, and clinical outcomes were compared between the groups. ResultsThere were no significant differences in the patient demographic and surgical data between the groups. The cut-off values for the total DAR (T-DAR) and the sagittal DAR (S-DAR) were 20.2 and 16.4, respectively (p=0.018 and 0.010). Both values were significantly associated with complications (p=0.016 and 0.005). In the higher T-DAR group, total complications (12 vs. 21, p=0.042) and late-onset complications (3 vs. 9, p=0.036) were significantly correlated with the T-DAR. The number of patients experiencing complications (9 vs. 11, p=0.029) and the total number of complications (13 vs. 20, p=0.015) were significantly correlated with the S-DAR. Worsening intraoperative neurophysiologic monitoring was more frequent in the higher T-DAR group (2 vs. 4) than in the higher S-DAR group (3 vs. 3). There was no difference in neurological deterioration between the groups after surgery. ConclusionBoth the T-DAR and the S-DAR are risk factors for complications after PVCR. Those who had a T-DAR >20.2 or S-DAR >16.4 experienced a higher rate of complications after PVCR.

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Neurological complications of thoracic posterior vertebral column resection for severe congenital spinal deformities

Cited by 23 publications

References 21 publications

Surgical and radiological outcomes after posterior vertebral column resection according to the surgeon's experience

Surgical and radiological outcomes after posterior vertebral column resection according to the surgeon's experience

Postoperative pulmonary complications following posterior spinal instrumentation and fusion for congenital scoliosis

Total Deformity Angular Ratio as a Risk Factor for Complications after Posterior Vertebral Column Resection Surgery

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