The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities

Abstract

Purpose To determine the risk factors of neurologic deficits during PVCR correction, so as to help improve safety during and after surgery. Methods A consecutive series of 76 patients with severe and rigid spinal deformities who were treated with PVCR at a single institution between October 2004 and July 2011 were included in our study. Of the 76 patients, 37 were male and 39 female, with an average age of 17.5 years (range 10-48 years). There were 52 adolescent patients (with an age \18 years) and 24 adult patients (with an age C18 years). Preoperatively, postoperatively and 6 months after surgery, we performed systemically neurologic function evaluations of each patients through meticulous physical examination. Any new abnormality or deterioration in evaluation of neurologic function than preoperative is reckoned postoperative neurologic deficits. Ten variables that might affect the safety of neurologic deficits during PVCR procedures, including imaging factors, clinical factors and operational factors, were analyzed using univariate analysis. Then the variables with statistical difference were analyzed by using multi-factor unconditional logistic regression analysis. Results No patient in this series had permanent paraplegia and nerve root injury due to operation. Change of neurologic status was found in six patients after surgery. Results of single-factor comparison demonstrated that the following seven variables were statistically different (P \ 0.05): location of apex at main curve (X 3 ), Cobb angle at the main curve at the coronal plane (X 4 ), scoliosis associated with thoracic hyperkyphosis (X 5 ), level of vertebral column resected (X 6 ), number of segmental vessels ligated (X 7 ), preexisting neurologic dysfunction (X 8 ), and associated with intraspinal and brain stem anomalies (X 9 ). The multi-factor unconditional logistic regression analysis revealed that X 8 (OR = 49.322), X 9 (OR = 18.423), X 5 (OR = 11.883), and X 6 (OR = 8.769) were independent and positively correlated with the neurologic deficit. Conclusions Preexisting neurologic dysfunction, associated with intraspinal and brain stem anomalies, scoliosis associated with thoracic hyperkyphosis and level of vertebral column resected are independent risk factors for neurologic deficits during PVCR procedure.

Posterior vertebral column resection in spinal deformity: a systematic review

“…Both patients wake up with intact neurologic function finally. The remaining patient with complete spinal cord injury was managed with methylprednisolone after excluding mechanical compression through emergency computed tomography (CT) and magnetic resonance imaging (MRI) examination and neurologic function was completely normal in 2 weeks [20]. Prevalence of revision was 6 % (31/390, 95 % CI 1-13 %).…”

“…Seven studies were excluded for insufficient number of patients (less than 10 patients) and one study was excluded due to the fact that the ''modified PVCR'' was performed. Seventeen studies from seven institutions [7,[9][10][11][13][14][15][16][17][18][19][20][21][22][23][24][25] were included for further analysis. To avoid overlap of patients in different studies, only one main publication from each institution was retained.…”

“…To avoid overlap of patients in different studies, only one main publication from each institution was retained. Thus, seven studies [7,9,16,20,21,24,25] (a total of 390 patients) were included finally (Fig. 1).…”

Can Intraoperative Spinal Cord Monitoring Reliably Help Prevent Paraplegia During Posterior Vertebral Column Resection Surgery?

“…Cheh et al [10] investigated SCM loss in pediatric patients who underwent surgical correction of thoracic kyphosis with various osteotomies and found complete loss of DNEP data in 21.4%. Also, Xie et al [21] studied neurologic deficits after PVCR in 76 patients and noted scoliosis associated with thoracic hyperkyphosis as a significant risk factor. The present study corroborates previous reports that kyphotic deformity inherently carries an increased risk of adverse neurologic outcomes after corrective surgery.…”

The impact of posterior temporary internal distraction on stepwise corrective surgery for extremely severe and rigid scoliosis greater than 130°

“…Posterior circumferential vertebral column resection (PVCR) produces a better correction rate (correction rate of 51-59 %) for severe and rigid scoliosis [1,[4][5][6]. Although it obviates a circumferential approach, a one-stage PVCR is associated with a high risk of neurological compromise during the acute correction, especially if there are significant kyphotic components, a history of intraspinal pathology or a history of previous spinal surgery [6][7][8].…”