NEUROLOGICAL COMPLICATIONS OF SPINAL DEFORMITY SURGERY – WHAT IS BEST PRACTICE?

Abstract

Introduction: It is the accepted dogma that should paralysis complicate spinal deformity surgery, then the internal fixation should be removed within three hours. This dogma is based on MacEwen’s paper in 1975 which related to the Harrington system and which did not contain statistical analysis (MacEwen G.D. et al, JBJS 557A, 1975,404-8). Since that time spinal cord monitoring systems have been developed and internal fixation systems have become considerably more complex. Does the accepted dogma need to be reviewed?

Methods and results: The author has reviewed the literature which contains statistical analysis of risk factors and results in relation to major neurological complications of spinal deformity surgery (Dove J. Résonance Européenes du Rachis 1999, 7[23]961–66). The risk factors are adult scoliosis, congenital and neuromuscular curves, kyphosis, combined anterior and posterior surgery, intra-operative hypertension, distraction and certain types of segmental fixation. Furthermore these risks are additive. MacEwen’s 1975 paper did not include statistical analysis and its conclusions are not borne out by the information within the paper. The only statistical analysis of the management of neurological complications has shown that surgical removal of the internal fixation was not related to neurological recovery (Paonessa K.G., Hutching F. Scoliosis Research Society Meeting. New York. Sept 1998).

Conclusion: Based on an analysis of the relevant literature and current clinical practice, the author suggests an algorithm to be followed by the surgeon faced with a major neurological complication of spinal deformity surgery. The author also raises the question as to whether the British Scoliosis Society should make a statement regarding “best practice” in such cases.