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Perioperative Neurologic Injury Associated With Rib-Based Distraction Surgery

  • Case Series
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Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Retrospective, comparative case series from the study group database.

Objectives

The primary objective was to report the neurologic injury rate for rib-based distraction surgery and determine whether preoperative diagnosis affects this rate. The secondary objective was to describe these injuries and outcome.

Summary of Background Data

Posterior distraction-based systems are commonly used to treat early-onset scoliosis. General complication rates for these surgeries are high; however, there are few reports in the literature on neurologic injury after rib-based distraction surgery. p ]Methods This was a retrospective review of the Children’s Spine Study Group database from 2004 to 2013. The researchers used the chi-square test to compare the distributions of proportions between diagnoses.

Results

A total of 524 patients were identified and treated with rib-based distraction surgery. The preoperative diagnoses consisted of 222 congenital/structural, 163 neuromuscular, 63 syndromic, 67 idiopathic, and 9 unknown. There were 9 neurologic injuries (7 clinical and 2 neuromonitoring alerts) for a neurologic injury rate of 1.7%. Using the Classification for Early-Onset Scoliosis, 8 patients were classified as congenital and 1 as neuromuscular. The neurologic injury rate in the congenital curves group was 3.6% and was 0.34% in non-congenital curves (p =.005). The proportion of injured patients with an additional secondary diagnosis was 3.82%, compared with 0.82% patients with only a primary diagnosis (p =.01). Eight injuries occurred at initial implantation and 1 at revision surgery. Most were brachial plexus (n = 5) with no complete spinal cord injuries. Four patients required return to surgery and 1 needed intraoperative intervention. At 4.2 years’ follow-up, 7 of 9 patients had full resolution of symptoms and 2 patients had residual upper extremity weakness. p ]Conclusions The rate of neurologic injury for patients treated with rib-based distraction surgery was 1.7%. Most injuries occurred with congenital diagnoses and they were more likely in patients with additional secondary diagnoses. These injuries were predominantly to the brachial plexus and generally resolved.

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Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax NS, Nova Scotia, B3K 6R8, Canada

    Luke E. Gauthier MD, Yousef Mandourah BSc, Alexandra Soroceanu MD & Ron El-Hawary MD

  2. Department of Orthopaedic Surgery, Mayo Clinic, Gonda Bldg 14 Fl, 200 First St. SW, Rochester, MN, 55905, USA

    Amy L. McIntosh MD

  3. Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Wood Bldg 2nd Fl, 34th & Civic Center Blvd, Philadelphia, PA, 19104, USA

    John M. Flynn MD

Authors
  1. Luke E. Gauthier MD
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  2. Yousef Mandourah BSc
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  3. Alexandra Soroceanu MD
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  4. Amy L. McIntosh MD
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  5. John M. Flynn MD
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  6. Ron El-Hawary MD
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Corresponding author

Correspondence to Ron El-Hawary MD.

Additional information

Author disclosures: LG (non-financial support from Children’s Spine Study Group during the conduct of the study); YM (non-financial support from Children’s Spine Study Group during the conduct of the study); SA (none); ALM (non-financial support from Children’s Spine Study Group during the conduct of the study); JMF (personal fees from Biomet, LWW outside the submitted work); REH (non-financial support from Children’s Spine Study Group during the conduct of the study; grants from Depuy-Synthes Spine, Medtronic Canada; personal fees from Depuy-Synthes Spine, Halifax Biomedical, Inc., outside the submitted work).

This work was supported by the Children’s Spine Study Groups, formerly known as the Chest Wall and Spine Deformity Study Group

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Gauthier, L.E., Mandourah, Y., Soroceanu, A. et al. Perioperative Neurologic Injury Associated With Rib-Based Distraction Surgery. Spine Deform 2, 481–488 (2014). https://doi.org/10.1016/j.jspd.2014.08.003

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  • DOI: https://doi.org/10.1016/j.jspd.2014.08.003

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