New neurologic deficit and recovery rates in the treatment of complex pediatric spine deformities exceeding 100 degrees or treated by vertebral column resection (VCR)

Abstract

Study design

Prospective multicenter international observational study.

Objective

To investigate incidence of new neurologic deficit (NND) and the long-term recovery patterns following complex pediatric spine deformity surgery.

Summary of background data

The SRS M&M reports identify pediatric patients as having higher rate of new neurologic deficit compared with adults, while congenital and neuromuscular deformities are associated with higher new neurologic risks. Very few studies have had the large numbers of pediatric patients with curves exceeding 100 deg to ascertain the new neurologic deficit (NND) rates and recovery patterns as it relates to curve laterality and diagnosis.

Method

The FOX pediatric database from 17 international sites was queried for New Neurologic Deficit (NND) as characterized by change in American Spinal Injury Association (ASIA) Lower or Upper Extremity Motor Score. Recovery rates at specific intervals were recorded and related to the curve type and etiology.

Results

Data of 286 consecutive patients with normal pre-operative neurologic exams were reviewed. There were 160 females vs 125 males with an average age of 14.6 years. NND occurred in 27 patients (9.4%) in the immediate post-operative period. Diagnostic categories included idiopathic scoliosis (3 patients); idiopathic kyphoscoliosis(5 patients); congenital scoliosis (7 patients); congenital kyphoscoliosis (4 patients); congenital kyphosis (6 patients), other kyphosis (1 patient) and syndromic (1 patient). 1 patient was lost to follow-up (f/u) after discharge; 1 had chronic deficits at the first post-operative erect visit (from discharge to 9 months f/u) and was subsequently lost to follow-up; 2 patients were improving at 1-year f/u but lost to subsequent f/u. 16 patients had normal neurologic function by the time of the first post-operative erect visit, 21 patients at 1-year f/u and 21 patients at the 2-year f/u. 2 patients (0.69%) had improved NND at 2-year mark.

Conclusion

A significant proportion of patients with complex spine deformity experience NND. However, significant improvement in neurologic function can be expected over time as seen in this study without additional surgical intervention in most cases. Congenital deformities accounted for 63% of the patients experiencing NND.

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Funding

Washington University Fox funds were received to support this work. This work was also partially funded with a Grant from K2M (Grant No: K2M/FC/060216).

Author information

Affiliations

Authors

Consortia

Contributions

Conceptualization and Design: OB-A, HOD, KPY, LGL, PDS, DJS, AFS, PON, SAS, MAE, HA, BAS, MCG, Fox Pediatric Spinal Deformity Study. Data Collection: OB-A, HOD, KPY, LGL, PDS, DJS, AFS, PON, SAS, MAE, HA, BAS, MCG, Fox Pediatric Spinal Deformity Study. Data Cleaning and Preparation: HOD, KPY, BAS. Data Analysis and interpretation: HOD, KPY, OB-A. Writing—Initial draft preparation: OB-A, KPY, HOD. Writing—Critical Review for important intellectual content: OB-A, HOD, KPY, LGL, PDS, DJS, AFS, PON, SAS, MAE, HA, BAS, MCG, Fox Pediatric Spinal Deformity Study. Final Approval: OB-A, HOD, KPY, LGL, PDS, DJS, AFS, PON, SAS, MAE, HA, BAS, MCG, Fox Pediatric Spinal Deformity Study. Funding acquisition, Fox Pediatric Spinal Deformity Study: MCG, OB-A, BAS. Resources: OB-A, MCG. Supervision: OB-A, MCG.

Corresponding author

Correspondence to Oheneba Boachie-Adjei.

Ethics declarations

Conflict of interest

Dr. Boachie-Adjei reports grants, personal fees and other from K2M, personal fees and other from WEIGAO, outside the submitted work. Dr. Lenke reports personal fees and other from Medtronic, personal fees and other from broadwater, personal fees and other from EOS Imaging, personal fees and other from EOS Imaging, personal fees and other from Quality Medical Publishing, personal fees and other from Stryker Spine, outside the submitted work. Dr. Sponseller reports grants, personal fees and other from DePuy Synthes, personal fees and other from JBJS, personal fees and other from Globus Medical, personal fees and other from OrthoPediatrics, outside the submitted work. Dr. Sucato reports personal fees and other from Globus Medical, outside the submitted work. Dr. Samdani reports personal fees and other from DePuy Synthes, personal fees and other from Globus Medical, personal fees and other from NuVasive, personal fees and other from Ethicon, personal fees and other from Stryker Spine, personal fees and other from Zimmer Biomet, outside the submitted work. Dr. Newton reports grants from Alphatec Spine, grants, personal fees and other from DePuy Synthes, personal fees and other from Electrocore, grants from EOS Imaging, grants, personal fees and other from K2M, grants from Mazor Robotics, grants from Medtronic, grants from NuVasive, grants from OrthoPediatrics, grants, personal fees and other from Thieme Publishing, outside the submitted work. Dr. Shah reports grants, personal fees and other from DePuy Synthes, other from K2M, other from Globus Medical, other from NuVasive, outside the submitted work. Dr. Gupta reports grants from AOSpine, personal fees and other from DePuy Synthes, other from Innomed, other from Johnson & Johnson, personal fees and other from Medtronic, grants from OMeGA, personal fees and other from perForm Biologics, other from Proctor & Gamble, outside the submitted work. For the remaining authors none were declared.

IRB approval statement

Central Institutional Review Board (IRB) approval was obtained by the main Principal Investigator of the FOX Pediatric Spinal Deformity Study. Additional IRB approvals were obtained from all investigational sites that enrolled patients into the Fox Pediatric Spinal Deformity Study.

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Boachie-Adjei, O., Duah, H.O., Yankey, K.P. et al. New neurologic deficit and recovery rates in the treatment of complex pediatric spine deformities exceeding 100 degrees or treated by vertebral column resection (VCR). Spine Deform (2020). https://doi.org/10.1007/s43390-020-00211-4

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Keywords

  • New Neurologic Deficit
  • Complex Spine Deformity
  • Neurologic recovery
  • Neurologic complications