Spinal Cord Intramedullary Pressure in Thoracic Kyphotic Deformity

Farley, Chad W.; Curt, Bradford A.; Pettigrew, David B.; Holtz, Jeffrey R.; Dollin, Neal; Kuntz, Charles

doi:10.1097/brs.0b013e31822dd69b

Cited by 39 publications

(13 citation statements)

References 15 publications

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“…First, kyphotic deformity may induce anterior spinal cord pathology through direct compression against the posterior vertebral body and may increase longitudinal spinal cord tension due to tethering by the dentate ligaments and cervical nerve roots. 18,30,31 Sagittal imbalance may itself result in neck pain, muscle fatigue, dysphagia, and alterations in visual horizon. 5,23 Compensation for global or regional sagittal imbalance places stress on the surrounding ligaments, muscles, and soft tissues and may result in increased pain and fatigue.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Cervical Sagittal Imbalance Negatively Affects Outcomes After Surgery for Cervical Spondylotic Myelopathy

Roguski

Benzel

Curran

et al. 2014

Spine

130

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Study Design Prospective observational cohort study Objective To determine if postoperative cervical sagittal balance is an independent predictor of HR-QOL outcome following surgery for CSM. Summary of Background Data Both ventral and dorsal fusion procedures for cervical spondylotic myelopathy (CSM) are effective at reducing the symptoms of myelopathy. The importance of cervical sagittal balance in predicting overall HR-QOL outcome following ventral versus dorsal surgery for CSM has not been previously explored. Methods A prospective, nonrandomized cohort of 49 patients undergoing dorsal and ventral fusion surgery for CSM was examined. Preoperative and postoperative C2-C7 sagittal vertical axis (SVA) was measured on standing lateral cervical spine radiographs. Outcome was assessed with two disease-specific measures – the mJOA scale and the Oswestry NDI- and two generalized outcome measures – the SF-36 PCS and EQ-5D. Assessments were performed preoperatively, and at 3 months, 6 months, and 1 year postoperatively. Statistical analyses were performed using SAS v.9.3 (Cary, NC). Results Most patients experienced improvement in all outcome measures regardless of approach. Both preoperative and postoperative C2-C7 SVA measurements were independent predictors of clinically significant improvement in SF-36 PCS scores (p=0.03 and p=0.02). The majority of patients with C2-C7 SVA values greater than 40mm did not improve from an overall HR-QOL perspective (SF-36 PCS) despite improvement in myelopathy. The postoperative sagittal balance value was inversely correlated with a clinically significant improvement of SF-36 PCS scores in patients undergoing dorsal surgery but not ventral surgery (p=0.03 vs. p=0.93). Conclusions Preoperative and postoperative sagittal balance measurements independently predict clinical outcomes following surgery for CSM.

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Section: Discussionmentioning

confidence: 99%

Postoperative Cervical Sagittal Imbalance Negatively Affects Outcomes After Surgery for Cervical Spondylotic Myelopathy

Roguski

Benzel

Curran

et al. 2014

Spine

130

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“…In a dynamic flexion cadaveric study, Farley et al [9] found that, in thoracic kyphosis exceeding 63°, spinal cord intramedullary pressure increased significantly compared with less substantial curves in the same specimen. However, a change of intramedullary pressure with progressive increases in the kyphosis angle on specimens did not correlate with spinal cord stenosis in the thoracic spine [9].…”

Section: Spinal Cord Ischemiamentioning

confidence: 99%

Spinal Cord Injury After Extremity Surgery in Children With Thoracic Kyphosis

Pruszczyński

Mackenzie

Rogers

et al. 2015

Clin Orthop Relat Res

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Background Spinal cord injury is a rare complication after lower extremity surgery in children with skeletal dysplasia and thoracic kyphosis. We encountered two patients who had this complication, from among 51 (39 from Nemours/Alfred I. duPont Hospital for Children and 12 from Seattle Children's Hospital) who underwent lower extremity surgery during an 8.5-year period (June 2004 to December 2012). Because spinal cord injury is a devastating complication likely not known to most physicians treating patients with skeletal dysplasias, we sought to examine factors that may contribute to this rare complication. Case Description We performed a retrospective review of two patients with skeletal dysplasia who had paraplegia develop after extremity surgery. Outcome measures included operative time, vital signs, and postsurgery recovery of neurologic deficit. MR images were reviewed. Two patients were found-an 8.5-year-old boy with spondyloepiphyseal dysplasia congenita with a 76°-thoracic kyphosis apex at T4 and a 6.5-year-old boy with mucopolysaccharidosis type 1-H with an 80°-thoracic kyphosis apex at T2. Bilateral proximal femoral osteotomies or bilateral innominate and proximal femoral osteotomies had been performed. The spinal cord injuries occurred at the apex of the kyphosis as determined by clinical examination and MRI assessment. In both patients, the mean arterial blood pressure decreased below 50 mm Hg and might be a factor in the etiology of the paralysis. The first patient recovered motor function in 5 months; the second had no recovery. Literature Review Paraplegia is extremely rare after nonspine operations. Many factors contribute to the risk for a spinal cord event: low mean arterial pressure, duration of the surgery, position on the operating table, the kyphotic spine deformity, or unappreciated vascular disease. Motorevoked potentials and somatosensory-evoked potentials together potentially provide high sensitivity and specificity for predicting a postoperative neurologic deficit. Clinical Relevance Based on our two patients with skeletal dysplasia and a literature review of patients with hyperkyphosis undergoing extremity surgery, the surgeon must be aware of the risk of spinal cord injury. Careful preoperative assessment possibly including MRI of the spine is recommended. Mean arterial pressure should be maintained at a safe level; neuromonitoring should be considered.

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“…For this phenomenon, the pathological change in spinal TB possibly started as a result of chronic vertebral destruction and kyphotic deformity that subsequently induced the compression of the spinal cord, thereby causing neurological deficits, which differ from an acute spinal cord injury. In other words, adaptations may be observed with chronic deformity, although the alleviation of all pressure changes in the vertebral canal by chronicity cannot be assumed (4). Hence, the therapeutic effect of rapid spinal cord decompression was not necessarily better than that of a slightly delayed decompression.…”

Section: Statistical Resultsmentioning

confidence: 99%