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Delayed postoperative cervical spinal cord ischemic lesion after a thoracolumbar fusion for syndromic scoliosis: a case report and systematic review of the literature

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Abstract

Introduction

We report a case and a literature review of delayed postoperative cervical spinal cord injury after thoraco-lumbar spine surgery.

Case report

A 13-year-old Prader-Willi Syndrome female was treated by a T3-L5 posterior spine fusion for progressive scoliosis. Intraoperative neuromonitoring and immediate postoperative neurological examination were normal. Sixty hours after surgery, she developed a tetraplegia. The immediate MRI and CT scan of the spine were negative. Two days after, a new MRI revealed an ischemic cervical lesion at the level C5-C6. After 1 week, she gradually improved breathing and motility/sensibility at the extremities. After 4 months of intensive neurologic rehabilitation, the patient improved to ASIA grade D and was discharged. At 1-year follow, the neurologic recovery was nearly completed.

Methods

We performed a systematic review of the literature through PubMed and Embase database focused on delayed postoperative cervical spinal cord lesion after a thoraco-lumbar fusion for spinal deformity.

Results

Only 14 cases of neurological injuries at levels above the site of surgery have been previously reported and never in Prader Willy Syndrome. All patients were adolescent and 86,7% were females but no specific risk factors were found.

Conclusions

Delayed postoperative neurological deficit far from the surgical site can be considered a specific subgroup of these rare complication that can occur several hours after spine surgery, regardless of intraoperative complication. Despite the rarity of this complication, clinicians should be aware of it. Perioperative optimization of spinal cord perfusion and close neurological examination in first postoperative days may be helpful to quickly recognize and treat this complication.

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Abbreviations

DPND:

Delayed postoperative neurologic deficits

PWS:

Prader-Willi syndrome

PRISMA:

Systematic Reviews and Meta-Analysis

References

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Authors and Affiliations

  1. Spine Surgery Unit III-Scoliosis, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy

    Alessio Lovi, Francesca Manfroni, Andrea Luca, Lisa Babbi & Marco Brayda-Bruno

Authors
  1. Alessio Lovi
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  2. Francesca Manfroni
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  3. Andrea Luca
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  4. Lisa Babbi
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  5. Marco Brayda-Bruno
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Corresponding author

Correspondence to Francesca Manfroni.

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This article was approved by the Scientific Board of our Institution.

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Informed consent for publication was obtained from the involved patient’s parents (underage patient).

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Lovi, A., Manfroni, F., Luca, A. et al. Delayed postoperative cervical spinal cord ischemic lesion after a thoracolumbar fusion for syndromic scoliosis: a case report and systematic review of the literature. Childs Nerv Syst 38, 1011–1015 (2022). https://doi.org/10.1007/s00381-021-05336-z

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  • DOI: https://doi.org/10.1007/s00381-021-05336-z

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