scholarly journals Loss of temperature and pain sensation as risk marker of neurological complications in surgical correction of severe spinal deformity

2017 ◽  
Vol 5 (4) ◽  
pp. 5-15 ◽  
Author(s):  
Elena N. Shchurova ◽  
Marat S. Saifutdinov ◽  
Sergei O. Ryabykh
Keyword(s):  
Spinal Cord ◽  
Spinal Deformity ◽  
Deformity Correction ◽  
Neurological Complications ◽  
Surgical Correction ◽  
Type I ◽  
Spinal Deformities ◽  
Response Type ◽  
Type V ◽  
Severe Spinal Deformity

Background. Treatment of severe spinal deformity remains a challenging surgical problem, with an iatrogenic injury to the spinal cord being a critical complication. There is a high risk of neurological deficit following surgical correction of a severe spinal deformity. Aim. To determine the relationship between the extent of disturbed thermal and pain sensations at Th1-S2 dermatomas and the intensity of the spinal cord pathways’ responses to surgical correction of the severe spinal deformity. Material and methods. We reviewed 58 patients with severe spinal deformities of different etiologies (mean age, 15.7±0.8 years). All patients underwent surgical deformity correction followed by thoracic/thoracolumbar spine fixation by using a variety of internal transpedicular fixations. Intraoperative neurophysiological monitoring (IONM) with transcranial motor-evoked potentials (MEPs) was used during operative interventions. Preoperative and postoperative thermal and pain sensations were assessed in Th1-S2 dermatomas to the right and left by using an electrical aesthesiometer. Results. The extent of disturbed preoperative and postoperative thermal and pain sensations in Th1-S2 dermatomas before and after correction of spinal deformities correlated with the response type scale (I–V) of the spinal cord pathways to the surgical correction we offered. Correlation between the response type and characteristics of thermal and pain sensations was mostly revealed by the test results for the thermal pain threshold (thermal analgesia). The incidence of postoperative thermal analgesia increased monotonically from patients with response type I (persistent MEP form and amplitude-time parameters close to the baseline) to patients with response type V (higher risk of neurological complications). The overall rate of thermal analgesia increased after surgical correction of the spinal deformity relative to the baseline and was higher (≤8%) in patients with response type V. Conclusions. Surgeons and neurophysiologists who perform IONM should give careful attention to patients with severe spinal deformity who exhibit marked postoperative thermal analgesia.

scholarly journals Surgical correction of pediatric spinal deformities with coexisting intraspinal pathology: A case report and literature review

2021 ◽  
Vol 12 ◽  
pp. 381
Author(s):  
Daphne Li ◽  
Douglas E. Anderson ◽  
Russ P. Nockels
Keyword(s):  
Spinal Cord ◽  
Literature Review ◽  
Tumor Resection ◽  
Deformity Correction ◽  
Tethered Cord ◽  
Surgical Correction ◽  
Spinal Deformities ◽  
Medline Search ◽  
Scoliosis Correction

Background: Surgical correction of spinal deformities with coexisting intraspinal pathology (SDCIP) requires special consideration to minimize risks of further injury to an already abnormal spinal cord. However, there is a paucity of literature on this topic. Here, the authors present a pediatric patient with a residual pilocytic astrocytoma and syringomyelia who underwent surgical correction of progressive postlaminectomy kyphoscoliosis. Techniques employed are compared to those in the literature to compile a set of guidelines for surgical correction of SDCIP. Methods: A systematic MEDLINE search was conducted using the following keywords; “pediatric,” “spinal tumor resection,” “deformity correction,” “postlaminectomy,” “scoliosis correction,” “intraspinal pathology,” “tethered cord,” “syringomyelia,” or “diastematomyelia.” Recommendations for surgical technique for pediatric SDCIP correction were reviewed. Results: The presented case demonstrates recommendations that primarily compressive forces on the convexity of the coronal curve should be used when performing in situ correction of SDCIP. Undercorrection is favored to minimize risks of traction on the abnormal spinal cord. The literature yielded 13 articles describing various intraoperative techniques. Notably, seven articles described use of compressive forces on the convex side of the deformity as the primary mode of correction, while only five articles provided recommendations on how to safely and effectively surgically correct SDCIP. Conclusion: The authors demonstrated with their case analysis and literature review that there are no clear current guidelines regarding the safe and effective techniques for in situ correction and fusion for the management of pediatric SDCIP.

scholarly journals Halo-gravity traction in the treatment of complex (>100°) scoliotic deformities of the spine in children: a review of clinical cases

2020 ◽  
pp. 67-71
Author(s):  
A.F. Levytskyi ◽  
◽  
V.A. Rogozinskyi ◽  
M.M. Dolianytskyi ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Deformity ◽  
Deformity Correction ◽  
Neurological Complications ◽  
Spinal Deformities ◽  
Specialized Hospital ◽  
Definition Of ◽  
Type 3

Relevance. The definition of «complex spinal deformity» remains rather vague, but in most publications mark it as a deformation, which on average exceeds 100 degrees. Modern surgical practice of one-stage correction of complex spinal deformities includes performing osteotomies of the spine, which significantly improves the possibility of deformity correction, but also increases the risk of neurological complications and the volume of intraoperative blood loss. The aim. To improve the results of surgical treatment of patients with complex spinal deformities through the preliminary use of halogravitational traction and to establish an effective and safe algorithm for the treatment of complex spinal deformities in children. Materials and methods. During the period from 2008 to 2018, the Orthopedic and Traumatology Department of the National Children’s Specialized Hospital «OKHMATDYT» treated 48 children with complex spinal deformities (>100°) using halo-gravity traction. Of these, 32 are boys and 16 are girls. The average age of the patients was 12.9 years. The average Risser score was 4.2 (P>0.01). 27.1% of patients had type 1 deformity according to Lenke, type 2 – 54.1%, type 3 – 8.3%, type 4 – 6.4%, type 5 – 4.1%. Results and discussion. Using of halo- gravity traction for the preoperative reduction of spinal deformity and prevention of neurological disorders, the average duration of spinal traction application was 46 (P>0.01) days. A weight of 40–50% of the patient’s body weight was used. After the stage of halo-gravity traction, the spine was stabilized with a polysigmentary construction. Conclusion. Halo-gravity traction as a first stage of severe scoliotic spinal deformations treatment allows to increase the mobility of the vertebral column and to adjust spinal cord step by step for the next correction treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: spinal deformity, halo-gravity traction, surgical treatment.

scholarly journals Risk factors for neurological complications in severe and rigid spinal deformity correction of 177 cases

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jian Chen ◽  
Xie-xiang Shao ◽  
Wen-yuan Sui ◽  
Jing-fan Yang ◽  
Yao-long Deng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Spinal Deformity ◽  
Deformity Correction ◽  
Neurological Complications ◽  
Anterior Column ◽  
Functional Classification ◽  
Correction Rate ◽  
Kyphosis Correction ◽  
Anterior Column Support

Abstract Background Difficult procedures of severe rigid spinal deformity increase the risk of intraoperative neurological injury. Here, we aimed to investigate the preoperative and intraoperative risk factors for postoperative neurological complications when treating severe rigid spinal deformity. Methods One hundred seventy-seven consecutive patients who underwent severe rigid spinal deformity correction were assigned into 2 groups: the neurological complication (NC, 22 cases) group or non-NC group (155 cases). The baseline demographics, preoperative spinal cord functional classification, radiographic parameters (curve type, curve magnitude, and coronal/sagittal/total deformity angular ratio [C/S/T-DAR]), and surgical variables (correction rate, osteotomy type, location, shortening distance of the osteotomy gap, and anterior column support) were analyzed to determine the risk factors for postoperative neurological complications. Results Fifty-eight patients (32.8%) had intraoperative evoked potentials (EP) events. Twenty-two cases (12.4%) developed postoperative neurological complications. Age and etiology were closely related to postoperative neurological complications. The spinal cord functional classification analysis showed a lower proportion of type A, and a higher proportion of type C in the NC group. The NC group had a larger preoperative scoliosis angle, kyphosis angle, S-DAR, T-DAR, and kyphosis correction rate than the non-NC group. The results showed that the NC group tended to undergo high-grade osteotomy. No significant differences were observed in shortening distance or anterior column support of the osteotomy area between the two groups. Conclusions Postoperative neurological complications were closely related to preoperative age, etiology, severity of deformity, angulation rate, spinal cord function classification, intraoperative osteotomy site, osteotomy type, and kyphosis correction rate. Identification of these risk factors and relative development of surgical techniques will help to minimize neural injuries and manage postoperative neurological complications.

Fluctuations in Spinal Cord Perfusion During Adult Spinal Deformity Correction Identify Neurologic Changes: Proof of Concept

2016 ◽  
Vol 85 ◽  
pp. 365.e1-365.e6 ◽  
Author(s):  
Jay D. Turner ◽  
Robert K. Eastlack ◽  
Zaman Mirzadeh ◽  
Stacie Nguyen ◽  
Jeff Pawelek ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Proof Of Concept

scholarly journals Perioperative challenges in the surgical management of ankylosing spondylitis

2008 ◽  
Vol 24 (1) ◽  
pp. E10 ◽  
Author(s):  
Daniel M. Sciubba ◽  
Clarke Nelson ◽  
Patrick Hsieh ◽  
Ziya L. Gokaslan ◽  
Steve Ondra ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Spinal Deformity ◽  
Patient Management ◽  
Perioperative Complications ◽  
Deformity Correction ◽  
Neurological Deficits ◽  
Spinal Lesions ◽  
Increased Risk ◽  
Surgical Manipulation ◽  
Severe Spinal Deformity

✓ Patients with ankylosing spondylitis (AS) who present with spinal lesions are at an increased risk for developing perioperative complications. Due to the rigid yet brittle nature of the ankylosed spines commonly occurring with severe spinal deformity, patients are more prone to developing neurological deficits. Such risks are potentially increased not only during surgical manipulation or deformity correction, but also during image acquisition, positioning within the operating room, and intubation. In this review the complications of AS are reviewed, and recommendations are provided to avoid problems during each stage of patient management.

CONGENITAL THORACOLUMBAR SPINE DEFORMITIES

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A78-A85 ◽  
Author(s):  
Hamidreza Aliabadi ◽  
Gerald Grant
Keyword(s):  
Surgical Treatment ◽  
Spinal Deformity ◽  
Congenital Anomalies ◽  
Thoracolumbar Spine ◽  
Deformity Correction ◽  
Spinal Deformities ◽  
Spine Deformities ◽  
Frequent Reason

ABSTRACT CONGENITAL THORACOLUMBAR SPINAL deformities are a common and frequent reason for referral to spine surgeons. Neurosurgeons also treat many neurological diagnoses which may result in a progressive spinal deformity, such as scoliosis. Here we review a variety of congenital anomalies and address the maldevelopments associated with each, as well as the appropriate evaluation of such patients including nonoperative and operative approaches. Advances in the field of spinal deformity correction now allow us to better treat individuals with these types of deformities. It is important for the practicing neurosurgeon to be knowledgeable of surgical and nonsurgical treatments of patients with congenital thoracolumbar spinal deformities in order to better understand which patients will ultimately progress and necessitate surgical treatment.

VERTEBRAL COLUMN RESECTION FOR RIGID SPINAL DEFORMITY

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A177-A182 ◽  
Author(s):  
Justin S. Smith ◽  
Vincent Y. Wang ◽  
Christopher P. Ames
Keyword(s):  
Spinal Deformity ◽  
Vertebral Column ◽  
Surgical Techniques ◽  
Deformity Correction ◽  
Postoperative Management ◽  
Three Dimensions ◽  
Spinal Deformities ◽  
Vertebral Column Resection ◽  
Case Examples ◽  
Significant Correction

ABSTRACT OBJECTIVE Vertebral column resection (VCR) is a surgical technique that may be applied for correction of moderate to severe spinal deformities, including those with large rigid curves, fixed trunk translation, or asymmetry between the length of the convex and concave column of the deformity. This article reviews the VCR technique as it relates to correction of rigid spinal deformity, including case examples to illustrate its application. METHODS The literature was reviewed in reference to the use of VCR for correction of rigid spinal deformity. RESULTS VCR involves complete resection of one or more vertebral segments using either combined anterior and posterior approaches or a posterior-only approach and enables significant deformity correction in all three dimensions. Herein, we provide description of the indications, preoperative planning, surgical techniques, complication avoidance, postoperative management, and case examples for VCR. CONCLUSION VCR enables significant correction of rigid spinal deformities in cases in which less aggressive approaches are not adequate.

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