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 ≥18 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.
Similar content being viewed by others
References
Xie J, Wang Y, Zhang Y et al (2010) Posterior vertebral column resection for correction of severe rigid spinal deformity (abstract). In: The 45th annual meeting of The Scoliosis Research Society, Kyoto
Suk SI, Kim JH, Kim WJ et al (2002) Posterior vertebral column resection for severe spinal deformities. Spine 27:2374–2382
Suk SI, Chung ER, Kim JH et al (2005) Posterior vertebral column resection for severe rigid scoliosis. Spine 30:1682–1687
Suk SI, Chung ER, Lee SM et al (2005) Posterior vertebral column resection in fixed lumbosacral deformity. Spine 30:E703–E710
Lenke LG, O’Leary PT, Bridwell KH et al (2009) Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine 34:2213–2221
Lenke LG, Sides BA, Koester LA et al (2010) Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res 468:687–699
Zhou C, Liu L, Song Y, Liu H, Li T, Gong Q, Zeng J, Kong Q (2011) Anterior and posterior vertebral column resection for severe and rigid idiopathic scoliosis. Eur Spine J 20(10):1728–1734
Wang Y, Lenke LG (2011) Vertebral column decancellation for the management of sharp angular spinal deformity. Eur Spine J 20(10):1703–1710
Bakaloudis G, Lolli F, Di Silvestre M, Greggi T, Astolfi S, Martikos K, Vommaro F, Barbanti-Brodano G, Cioni A, Giacomini S (2011) Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J20(Suppl 1):S95–S104
Dorward IG, Lenke LG (2010) Osteotomies in the posterior-only treatment of complex adult spinal deformity: a comparative review. Neurosurg Focus 28:E4
Hamzaoglu A, Alanay A, Ozturk C et al (2011) Posterior vertebral column resection in severe spinal deformities. A total of 102 Cases. Spine 36:E340–E344
Musson RE, Warren DJ, Bickle I et al (2010) Imaging in childhood scoliosis: a pictorial review. Postgrad Med J 86:419–427
Inoue M, Minami S, Nakata Y et al (2005) Preoperative MRI analysis of patients with idiopathic scoliosis: a prospective study. Spine 30:108–114
Pahys JM, Samdani AF, Betz RR et al (2009) Intraspinal anomalies in infantile idiopathic scoliosis. Prevalence and role of magnetic resonance imaging. Spine 34:E434–E438
Benli IT, Uzumougil O, Aydin E et al (2006) Magnetic resonance imaging abnormalities of neural axis in Lenke type I idiopathic scoliosis. Spine 31:1828–1833
Kontio K, Davidson D, Letts M (2002) Management of scoliosis and syringomyelia in children. J Pediatr Orthop 22:771–779
Tubbs RS, McGirt MJ, Oakes WJ (2003) Surgical experience in 130 pediatric patients with Chiari I malformations. J Neurosurg 99:291–296
Bradlley LJ, Ratahi ED, Crawford HA et al (2007) The outcomes of scoliosis surgery in patients with syringomyelia. Spine 32:2327–2333
Ferguson RL, DeVine J, Stasikelis P et al (2002) Outcomes in surgical treatment of ‘idiopathic-like’ scoliosis associated with syringomyelia. J Spinal Disord Tech 15:301–306
Grande AW, Maher PC, Morgan CJ et al (2006) Vertebral column subtraction osteotomy for recurrent tethered cord syndrome in adults: a cadaveric study. J Neurosurg Spine 4:478–484
Kawahara N, Tomita K, Kobayashi T et al (2005) Influence of acute shortening on the spinal cord: an experimental study. Spine 30:613–620
Alemdarog ˘lu KB, Atlihan D, Cimen O et al (2007) Morphometric effects of acute shortening of the spine: the kinking and the sliding of the cord, response of the spinal nerves. Eur Spine J 16:1451–1457
Kanno H, Aizawa T, Ozawa H et al (2008) Spine-shortening vertebral osteotomy in a patient with tethered cord syndrome and a vertebral fracture case report. J Neurosurg Spine 9:62–66
Matsumoto Morio, Watanabe Kota, Tsuji Takashi et al (2009) Progressive kyphoscoliosis associated with tethered cord treated by posterior vertebral column resection. A case report. Spine 34:E965–E968
Xie J, Wang Y, Zhao Z, Zhang Y, Si Y, Yang Z et al (2011) One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary? Eur Spine J 20:1106–1113
Xie J, Li T, Wang Y, Zhao Z, Zhang Y, Bi N ( (2012) Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVC. Eur Spine J 21:705–710
Kato S, Kawahara N, Tomita K et al (2008) Effects on spinal cord blood flow and neurologic function secondary to interruption of bilateral segmental arteries which supply the artery of Adamkiewicz: an experimental study using a dog model. Spine 33:1533–1541
Ueda Y, Kawahara N, Tomita K et al (2005) Influence on spinal cord blood flow and function by interruption of bilateral segmental arteries up to three levels: experimental study in dogs. Spine 30:2239–2243
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Xie, JM., Zhang, Y., Wang, YS. et al. The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities. Eur Spine J 23, 149–156 (2014). https://doi.org/10.1007/s00586-013-2793-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-013-2793-6