Postoperative neurological deficits in segmental spinal instrumentation. A study using spinal cord monitoring.

Wilber, R. Geoffrey; Thompson, George H.; Shaffer, John W.; Brown, R. H.; Nash, Clyde L.

doi:10.2106/00004623-198466080-00005

Cited by 225 publications

(93 citation statements)

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“…In the series of 15 patients with more severe, neurological scoliosis[100°, La Rosa et al achieved a 70% initial reduction (from 107 to 32°) and lost only 7°of correction after an average follow-up of 3 years [20]. The intermediate-term results reported here on the corrective efficacy of the UC in the coronal plane are not inferior to results observed with other spinal anchors that have known safety issues [2,[22][23][24][25][26][27]]. An initial average thoracic curve correction from 54°to 27°(50%) achieved in 75 AIS patients with hook hybrid constructs (before the development of the UC) was followed by a loss of 4°o bserved 2 years postoperatively [13].…”

Section: Discussionmentioning

confidence: 67%

Use of the Universal Clamp in adolescent idiopathic scoliosis for deformity correction and as an adjunct to fusion: 2-year follow-up

Gauzy

Jouve

Accadbled

et al. 2011

Journal of Children's Orthopaedics

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Purpose Among posterior surgical techniques for treating adolescent idiopathic scoliosis (AIS), hybrid constructs with pedicle-screw fixation in the lumbar spine and other anchors in the thoracic spine have been reported to provide to be of more physiological value in postoperative thoracic kyphosis than all-screw constructs. The Universial Clamp (UC) equipped with a soft sublaminar band is a relatively new thoracic anchor that can be used in hybrid constructs. A dedicated reduction tool that applies traction to the sublaminar band permits gentle translation of the thoracic curve to the precontoured fusion rods, which have been previously anchored distally by pedicle screws and proximally by hooks in a claw configuration. The aim of this study was to evaluate radiographic results of AIS treatment using UC hybrid constructs.Methods This was a prospective case series in which 29 consecutive patients with Lenke type 1, 2 or 3 AIS operated on by two surgeons in two centers were followed for 24 months. Necessity for anterior release was an exclusion criterion. Results A total of 5.4 ± 1.4 UCs were used per patient. The major thoracic curve was reduced from 55 ± 7°to 14 ± 6°at 1 month and 17 ± 6°at 24 months (correction 70%) without complications. In the patients who had less than 20°of T5-T12 kyphosis preoperatively, thoracic kyphosis improved from 14 ± 4°to 20 ± 3°at 3 months and 24 ± 9°at 24 months. In the other patients, preoperative thoracic kyphosis (27°± 6°) was unchanged by the operation. Conclusion UC hybrid constructs appear to safely provide satisfying coronal correction while consistently improving thoracic kyphosis in patients who also have preoperative hypokyphosis. We hypothesize that diminution in thoracic kyphosis was consistently avoided due to the straightforward traction of the spine to the fusion rods into which the chosen kyphosis was contoured by the surgeon before applying the reduction tool to the sublaminar bands.

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Section: Discussionmentioning

confidence: 67%

Use of the Universal Clamp in adolescent idiopathic scoliosis for deformity correction and as an adjunct to fusion: 2-year follow-up

Gauzy

Jouve

Accadbled

et al. 2011

Journal of Children's Orthopaedics

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“…Although there are reported neurologic injuries while passing the sublaminar wires, [48][49][50][51][52][53][54][55] none of the patients treated in our study suffered this complication. It is possible that the wide release of the posterior elements with the complete excision of the ligamentum flavum could have helped in preventing this complication, as it makes this maneuver easier to perform.…”

Section: Discussionmentioning

confidence: 82%

Does Wide Posterior Multiple Level Release Improve the Correction of Adolescent Idiopathic Scoliosis Curves?

Pizones

Izquierdo

Sánchez-Mariscal

et al. 2010

Journal of Spinal Disorders &Amp; Techniques

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“…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%

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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Postoperative neurological deficits in segmental spinal instrumentation. A study using spinal cord monitoring.

Cited by 225 publications

References 0 publications

Use of the Universal Clamp in adolescent idiopathic scoliosis for deformity correction and as an adjunct to fusion: 2-year follow-up

Use of the Universal Clamp in adolescent idiopathic scoliosis for deformity correction and as an adjunct to fusion: 2-year follow-up

Does Wide Posterior Multiple Level Release Improve the Correction of Adolescent Idiopathic Scoliosis Curves?

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

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