The outcome following the development of neurological complications after corrective surgery for scoliosis varies from full recovery to a permanent deficit. This study aimed to assess the prognosis and recovery of major neurological deficits in these patients, and to determine the risk factors for non-recovery, at a minimum follow-up of two years. A major neurological deficit was identified in 65 of 8,870 patients who underwent corrective surgery for scoliosis, including eight with complete paraplegia and 57 with incomplete paraplegia. There were 23 male and 42 female patients. Their mean age was 25.0 years (SD 16.3). The aetiology of the scoliosis was idiopathic (n = 6), congenital (n = 23), neuromuscular (n = 11), neurofibromatosis type 1 (n = 6), and others (n = 19). Neurological function was determined by the American Spinal Injury Association (ASIA) impairment scale at a mean follow-up of 45.4 months (SD 17.2). the patients were divided into those with recovery and those with no recovery according to the ASIA scale during follow-up.Aims
Methods
This study, using a surgeon-maintained database, aimed to explore the risk factors for surgery-related complications in patients undergoing primary cervical spine surgery for degenerative diseases. We studied 5,015 patients with degenerative cervical diseases who underwent primary cervical spine surgery from 2012 to 2018. We investigated the effects of diseases, surgical procedures, and patient demographics on surgery-related complications. As subcategories, the presence of cervical kyphosis ≥ 10°, the presence of ossification of the posterior longitudinal ligament (OPLL) with a canal-occupying ratio ≥ 50%, and foraminotomy were selected. The surgery-related complications examined were postoperative upper limb palsy (ULP) with a manual muscle test (MMT) grade of 0 to 2 or a reduction of two grade or more in the MMT, neurological deficit except ULP, dural tear, dural leakage, surgical-site infection (SSI), and postoperative haematoma. Multivariate logistic regression analysis was performed.Aims
Methods
Aims. The aim of this study was to explore risk factors for complications associated with dural tear (DT), including the types of DT, and the intra- and postoperative management of DT. Patients and Methods. Between 2012 and 2017, 12 171 patients with degenerative lumbar diseases underwent primary lumbar spine surgery. We investigated five categories of potential predictors: patient factors (sex, age, body mass index, and primary disease), surgical factors (surgical procedures, operative time, and estimated blood loss), types of DT (inaccessible for suturing/clipping and the presence of cauda equina/nerve root herniation), repair techniques (suturing, clipping, fibrin glue, polyethylene glycol (PEG) hydrogel, and polyglycolic acid sheet), and postoperative management (drainage duration). Postoperative complications were evaluated in terms of dural leak, prolonged bed rest, headache, nausea/vomiting, delayed wound healing,
Aims. Spinal deformity surgery carries the risk of neurological injury. Neurophysiological monitoring allows early identification of intraoperative cord injury which enables early intervention resulting in a better prognosis. Although multimodal monitoring is the ideal, resource constraints make surgeon-directed intraoperative transcranial motor evoked potential (TcMEP) monitoring a useful compromise. Our experience using surgeon-directed TcMEP is presented in terms of viability, safety, and efficacy. Methods. We carried out a retrospective review of a single surgeon’s prospectively maintained database of cases in which TcMEP monitoring had been used between 2010 and 2017. The upper limbs were used as the control. A true alert was recorded when there was a 50% or more loss of amplitude from the lower limbs with maintained upper limb signals. Patients with true alerts were identified and their case history analyzed. Results. Of the 299 cases reviewed, 279 (93.3%) had acceptable traces throughout and awoke with normal clinical neurological function. No patient with normal traces had a
We report our experience of the monitoring of spinal somatosensory evoked potentials in 60 patients with neuromuscular scoliosis. In 15 cases a significant change occurred in the trace when a sublaminar wire was tightened. There were no
Aim:. Recent guidelines have been published by the Association of Neurophysiological Scientists / British Society for Clinical Neurophysiology (ANS/BSCN) regarding the use of intra-operative neurophysiological monitoring (IOM) during spinal deformity procedures. We present our unit's experience with IOM and the compliance with national guidelines. Method:. All patients undergoing intra-operative spinal cord monitoring during adult and paediatric spinal deformity surgery between Jan 2009 and Dec 2012 were prospectively followed. The use of somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs) was recorded and monitoring outcomes were compared to post-operative clinical neurological outcomes. Compliance with the national ANS/BSCN guidelines was assessed. Results:. 333 patients were included in this study. IOM was successful in 312 patients (94%), with both MEPs and SSEPs obtained in 282 patients (85%). SEPs were achieved in 91% and MEPs in 87%. Aetiology was idiopathic in 199 cases, 53 neuromuscular, 28 degenerative, 16 congenital, 16 other. Nine patients had changes in IOM related to surgical activity; six had MEP changes only, three had MEPs and SSEPs changes. All but one of these changes returned to baseline following surgical action; the one remaining patient had a temporary
Purpose: The purpose of this study was to assess the efficacy and safety of treating extra-foramen discal herniation via a microsurgical extra-foramen approach. Material and methods: Fourteen patients underwent this surgical procedure which enables release of the roots outside the foramen while preserving the vertebral isthma. The technique is described in detail together with the postoperative period. All patients were reviewed clinically and radiologically at at least one year. The PROLO score was used to assess results. Results: Among the 14 operated patients, good or excellent results were obtained in 13, fair results in one. There was no
Purpose of Study: To observe the efficiency of the combined motor-somatosensory monitoring and somatosensory-alone monitoring to identify the intra-operative neurologic changes. Methods and Results: We retrospectively assessed 123 cases in our centre, who had complete neurophysiological report while undergoing corrective spinal deformity surgery with spinal monitoring, from 2004 to 2008. Combined motor-somatosensory, somatosensory-alone and motor-alone monitoring were applied in sixty five, fifty and eight operations, respectively. We also looked at the factors that could potentially affect the neuro-physiologic monitoring, such as preoperative neurological status, anaesthetic method, blood loss, competency level of the monitoring team and the reaction of the surgical team to a significant monitoring event. In total, there were only two cases of true positive event, defined as a significant intraoperative event and
Ten patients who suffered iatrogenic injury to a vertebral artery during anterior cervical decompression were reviewed to assess the mechanisms of injury, their operative management, and the subsequent outcome. All had been undergoing a partial vertebral body resection for spondylitic radiculopathy or myelopathy (4), tumour (2), ossification of the posterior longitudinal ligament (1), nonunion of a fracture (2), or osteomyelitis (1). The use of an air drill had been responsible for most injuries. The final control of haemorrhage had been by tamponade (3), direct exposure and electrocoagulation (1), transosseous suture (2), open suture (1), or open placement of a haemostatic clip (3). Five patients had
Since 1981, during operations for spinal deformity, we have routinely used electrophysiological monitoring of the spinal cord by the epidural measurement of somatosensory evoked potentials (SEPs) in response to stimulation of the posterior tibial nerve. We present the results in 1168 consecutive cases. Decreases in SEP amplitude of more than 50% occurred in 119 patients, of whom 32 had clinically detectable neurological changes postoperatively. In 35 cases the SEP amplitude was rapidly restored, either spontaneously or by repositioning of the recording electrode; they had no postoperative neurological changes. One patient had delayed onset of postoperative symptoms referrable to nerve root lesions without evidence of spinal cord involvement, but there were no false negative cases of intra-operative spinal cord damage. In 52 patients persistent, significant, SEP changes were noted without clinically detectable neurological sequelae. None of the many cases which showed falls in SEP amplitude of less than 50% experienced neurological problems. Neuromuscular scoliosis, the use of sublaminar wires, the magnitude of SEP decrement, and a limited or absent intra-operative recovery of SEP amplitude were identified as factors which increased the risk of
Sacrococcygeal chordoma is a slow growing, malignant tumour with a clinical poor outcome due to a high local recurrence (LR) rate. Several studies emphasize that margin-free tumour resection is the most important predictor of survival and LR in patients with sacrococcygeal chordoma. However, a high recurrence rate still remains. The purpose of this report is to define the role of postoperative radiotherapy (RT). 15 patients (7 females and 8 males) underwent surgical treatment for sacrococcygeal chordoma between 1981 and 2003. The mean age at surgery was 54 (range 31–70) years. The mean follow up was 8.5 (range 4 – 20) years. Most patients suffered from local swelling and pain; only one patient had a mild urinary continence being the only pre- and
Purpose: Isolated tumours of the peripheral nerves are exceptional and benign in 90% of the cases. They develop from the constitutive elements of the nerve and correspond to schwannomas in 80% of cases. Other tumours are much more rare and exhibit wide histological variability. Material and methods: Fifty-one patients were reviewed at mean 4.6 years. Forty-one had a resectable tumour: schwannoma (n=39), intranervous lipoma (n=2). Ten an unresectable tumour: solitary neurofibroma (n=5), peri-nervous hemangioma (n=3), neurofibrolipoma (n=2). We detailed the type of lesion, diagnostic elements, and results of complementary explorations. Enucleation was performed for resectable tumours. Epineurotomy for decompression with systematic interfascicular biopsy was performed in the event of an unresectable tumour. Results:
Introduction: Total en bloc spondylectomy (TES) as the only radical treatment option for sarcoma and solitary metastases of the spine was shown to markedly minimize local recurrences, improve patient quality of life and substantially increase overall survival rates. This study analyzes the onco-surgical results after multilevel thoracolumbar TES and reconstruction with a carbon composite vertebral body replacement system (CC-VBR) in a collective of patients. Methods: 26 patients (14f/12m; age 52±14y) treated with thoracolumbar multilevel TES (10x2, 12x3, 3x4, 1x5 segments) for spinal sarcomas (n=16), solitary metastases (n=5) and aggressive primary tumors (n=5) were retrospectively investigated. According to the classification system of Tomita et al. all patients were surgically staged as type 6 (multisegmental/extracom-partimental). Defect reconstruction (14 thoracic, 6 thoraco-lumbar and 6 lumbar) were performed with posterior stabilization and a CC-VBR. Patient charts and the current clinical follow-up results were analyzed for histopathological tumor type, pre- and postoperative data (symptoms, duration of surgery, blood loss, complications, intensive care, adjuvant therapies etc.) and course of disease. Latest radiographs and CT-scans were analyzed at follow up. Oncological status was evaluated using cumulative disease specific and metastases-free survival analysis. Results: With a mean follow up (100%) of 18 (4–44) months 24 patients (92%) were postoperatively ambulatory without any support.
Introduction: Total en bloc spondylectomy (TES) as the only radical treatment option for sarcoma and solitary metastases of the spine was shown to markedly minimize local recurrences, improve patient quality of life and substantially increase overall survival rates. Due to surgical difficulty of TES and complex biomechanical demands in defect reconstruction multisegmental tumor involvement of the spine has long been considered as a palliative situation, exceeding the limits of surgical feasibility. Thus, multilevel resections reports are very rare. For the first time, this study analyzes the onco-surgical results after multilevel thoracolumbar TES and reconstruction with a carbon composite vertebral body replacement system (CC-VBR) in a collective of patients. Methods: 18 patients (9f/9m; age 52±14y) treated with thoracolumbar multilevel TES (6x2, 9x3, 3x4 segments) for spinal sarcomas (n=9), solitary metastases (n=5) and aggressive primary tumors (n=3) were retrospectively investigated. According to the classification system of Tomita et al. all patients were surgically staged as type 6 (multisegmental/extracompartimental). Defect reconstruction (11 thoracic, 3 thoracolumbar and 4 lumbar) were performed with posterior stabilization and a CC-VBR. Patient charts and the current clinical follow-up results were analyzed for histopathological tumor type, pre- and postoperative data (symptoms, duration of surgery, blood loss, complications, intensive care, adjuvant therapies etc.) and course of disease. Latest radiographs and CT-scans were analyzed at follow up. Oncological status was evaluated using cumulative disease specific and metastases-free survival analysis. Results: With a mean follow up (100%) of 18 (4–44) months 17 patients (94%) were postoperatively ambulatory without any support.
The aim of this retrospective study was to compare the correction achieved using a convex pedicle screw technique and a low implant density achieved using periapical concave-sided screws and a high implant density. We hypothesized that there would be no difference in outcome between the two techniques. We retrospectively analyzed a series of 51 patients with a thoracic adolescent idiopathic scoliosis. There were 26 patients in the convex pedicle screw group who had screws implanted periapically (Group 2) and a control group of 25 patients with bilateral pedicle screws (Group 1). The patients’ charts were reviewed and pre- and postoperative radiographs evaluated. Postoperative patient-reported outcome measures (PROMs) were recorded.Aims
Methods
Aims. The aim of this study was to compare the outcomes of surgery
using growing rods in patients with severe versus moderate
early-onset scoliosis (EOS). Patients and Methods. A review of a multicentre EOS database identified 107 children
with severe EOS (major curve ≥ 90°) treated with growing rods before
the age of ten years with a minimum follow-up of two years and three
or more lengthening procedures. From the same database, 107 matched
controls with moderate EOS were identified. Results. The mean preoperative major curve was 101° (90 to 139) in the
severe group and 67° (33° to 88°) in the moderate group (p < 0.001),
which was corrected at final follow-up to 57° (10° to 96°) in the
severe group and 40° (3° to 85°) in the moderate group (p < 0.001).
T1-S1 height increased by a mean of 54 mm (-8 to 131) in the severe
group and 27 mm (-4 to 131) in the moderate group at the initial
surgery (p < 0.001), and by 50 mm (-17 to 200) and 54 mm (-11 to
212), respectively, during distraction (p = 0.84). The mean number
of complications per patient was 2.6 (0 to 14) in the severe group
and 1.9 (0 to 10) in the moderate group (p = 0.040). Five patients
(4.7%) in the severe group and three (2.8%) in the moderate group
developed a
We evaluated 56 patients for neurological deficit after enucleation of a histopathologically confirmed schwannoma of the upper limb. Immediately after the operation, 41 patients (73.2%) had developed a new neurological deficit: ten of these had a major deficit such as severe motor or sensory loss, or intolerable neuropathic pain. The mean tumour size had been significantly larger in patients with a major neurological deficit than in those with a minor or no deficit. After a mean 25.4 months (12 to 85), 39 patients (70%) had no residual neurological deficit, and the other 17 (30%) had only hypoaesthesia, paraesthesiae or mild motor weakness. This study suggests that a schwannoma in the upper limb can be removed with an acceptable risk of injury to the nerve, although a transient neurological deficit occurs regularly after the operation. Biopsy is not advised. Patients should be informed pre-operatively about the possibility of damage to the nerve: meticulous dissection is required to minimise this.