Prospective multicenter international observational study.
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.
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.
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.
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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Diab M, Smith AR, Kuklo TR (2007) Spinal Deformity Study Group. Neural complications in the surgical treatment of adolescent idiopathic scoliosis. Spine 32(24):2759–2763
Bianco K, Norton R, Schwab F, Smith JS, Klineberg E, Obeid I, Mundis G, Shaffrey CI, Kebaish K, Hostin R, Hart R (2014) Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients. Neurosurg Focus 36(5):E18
Boachie-Adjei O, Yagi M, Nemani VM, Sacramento-Dominguez C, Akoto H, Cunningham ME, Gupta M, Hess WF, Lonner BS, Mendelow MJ, Papadopoulus EC (2015) Incidence and risk factors for major surgical complications in patients with complex spinal deformity: a report from an SRS GOP site. Spine Deform 3(1):57–64
Boachie-Adjei O, Yagi M, Sacramento-Dominguez C, Akoto H, Cunningham ME, Gupta M, Hess WF, Lonner BS, Ayamga J, Papadopoulus E, Sanchez-Perez-Grueso F (2014) Surgical risk stratification based on preoperative risk factors in severe pediatric spinal deformity surgery. Spine Deform 2(5):340–349
Lenke LG, Newton PO, Sucato DJ, Shufflebarger HL, Emans JB, Sponseller PD, Shah SA, Sides BA, Blanke KM (2013) Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine. 38(2):119–132
Lü GH, Wang XB, Wang B, Li J, Kang YJ, Deng YW, Liu WD (2010) Complications of one stage posterior vertebral column resection for the treatment of severe rigid spinal deformities. Zhonghua wai ke za zhi [Chinese Journal of Surgery]. 48(22):1709–1713
Lenke LG, Sides BA, Koester LA, Hensley M, Blanke KM (2010) Vertebral column resection for the treatment of severe spinal deformity. Clin Ortho Related Res. 468(3):687–699
Hamilton DK, Smith JS, Sansur CA, Glassman SD, Ames CP, Berven SH, Polly DW Jr, Perra JH, Knapp DR, Boachie-Adjei O, McCarthy RE (2011) Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: a report of the scoliosis research society morbidity and mortality committee. Spine 36(15):1218–1228
Iyer S, Boachie-Adjei O, Duah HO, Yankey KP, Mahmud R, Wulff I, Tutu HO, Akoto H (2019) Halo gravity traction can mitigate preoperative risk factors and early surgical complications in complex spine deformity. Spine 44(9):629–636
Coe JD, Smith JS, Berven S, Arlet V, Donaldson W, Hanson D, Mudiyam R, Perra J, Owen J, Marks MC, Shaffrey CI (2010) Complications of spinal fusion for Scheuermann kyphosis: a report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine 35(1):99–103
Qiu Y, Wang S, Wang B, Yu Y, Zhu F, Zhu Z (2008) Incidence and risk factors of neurological deficits of surgical correction for scoliosis: analysis of 1373 cases at one Chinese institution. Spine. 33(5):519–526
Suk SI, Chung ER, Kim JH, Kim SS, Lee JS, Choi WK (2005) Posterior vertebral column resection for severe rigid scoliosis. Spine 30(14):1682–1687
Ma HS, Chen ZM, Yang B, Wu JG, Tan R, Wang XP (2012) Analysis of neurological deficits complications in the treatment of spinal deformity with posterior spinal osteotomy. Zhonghua wai ke za zhi [Chin J Surg]. 50(4):328–332
Boachie-Adjei O, Bradford DS (1991) Vertebral column resection and arthrodesis for complex spinal deformities. J Spinal Disord 4(2):193–202
Auerbach JD, Lenke LG, Bridwell KH, Sehn JK, Milby AH, Bumpass D, Crawford CH III, O’Shaughnessy BA, Buchowski JM, Chang MS, Zebala LP (2012) Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine 37(14):1198–1210
Xie J, Wang Y, Zhao Z, Zhang Y, Si Y, Li T, Yang Z, Liu L (2012) Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100. J Neurosurg 17(6):540–551
Yang C, Zheng Z, Liu H, Wang J, Kim YJ, Cho S (2016) Posterior vertebral column resection in spinal deformity: a systematic review. Eur Spine J 25(8):2368–2375
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).
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.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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
- New Neurologic Deficit
- Complex Spine Deformity
- Neurologic recovery
- Neurologic complications