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Iatrogenic paraplegia in spinal surgery

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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Paraplegia as a result of a surgical spinal procedure is a rare complication. The risk cannot be precisely quantified due to the lack of current data. The aim of this study was to record a sufficiently large number of major spinal operations, especially extended methods in scoliosis surgery. Hereby, a reliable statement regarding the risk of severe neurological complications with these surgical techniques should be possible. First, a retrospective analysis of patients from a German spine centre (spinal fusion) and a survey of 17 German centres of spinal surgery were conducted for the retrospective acquisition of severe iatrogenic neurological complications.

Materials and methods

The study included 1194 patients who underwent a spinal fusion during the period 1992–2002. The incidents of postoperative paraplegia are described in detail, and case studies done. Possible causes, methods of intraoperative monitoring and options of therapy are discussed according to research in relevant publications. Additionally, severe neurological complications of 3115 spinal operations were recorded in a standardised survey conducted throughout major German spinal centres.

Results

Of the 1194 patients surveyed, 7 (0.59%) experienced a postsurgical complete or incomplete paraplegia. In 3 of the recorded cases, the cause could be identified. The survey of 3115 scoliosis surgeries showed that iatrogenic paraplegia occurred with a frequency of 0.55%. The risks associated with short spinal fusions (0.14%), cervical discectomies (0.07%) and lumbar discectomies (0.03%) are considerably less.

Conclusion

Operative treatment of scoliosis with a high degree of correction carries a risk of neurological complications of about 0.5%. Mechanical as well as ischaemic damage to the spinal cord can be detected early by means of consistent intraoperative neuromonitoring.

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References

  1. Bacher T, Schiltenwolf M, Niethard FU et al (1999) The risk of paraplegia through medical treatment. Spinal Cord 37:172–182

    Google Scholar 

  2. Bracken MB, Collins WF, Freemann DF et al (1984) Efficacy of methylprednisolone in acute spinal cord injury. JAMA 251:45–52

    Article  CAS  PubMed  Google Scholar 

  3. Bracken MB, Shepard MJ, Collins WF et al (1990) A randomised, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the second national acute spinal cord injury study. N Engl J Med 322:1405–1411

    CAS  PubMed  Google Scholar 

  4. Bracken MB, Shepard MJ, Collins WF et al (1992) Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. J Neurosurg 76:23–31

    CAS  PubMed  Google Scholar 

  5. Cabana F, Pointillart V, Vital J et al (2000) Postoperative compressive spinal epidural hematomas. 15 cases and a review of the literature. Rev Chir Orthop Rep Appar Mot 86:335–345

    Google Scholar 

  6. Edwards CC, Heller JG, Murakami H (2002) Corporectomy versus laminoplasty for multilevel cervical myelopathy. An independent matched-cohort analysis. Spine 27:1168–1175

    Article  PubMed  Google Scholar 

  7. Faciszewski T, Winter RB et al (1995) The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine 20:1592–1599

    CAS  PubMed  Google Scholar 

  8. George ER, Scholten DJ, Buechler CM et al (1995) Failure of methylprednisolone to improve the outcome of spinal cord injuries. Am Surg 61:659–664

    CAS  PubMed  Google Scholar 

  9. Kou J, Fischgrund J, Biddinger A et al (2002) Risk factors for spinal epidural hematoma after spinal surgery. Spine 27:1670–1673

    Article  CAS  PubMed  Google Scholar 

  10. Legos JJ, Gopez JJ, Young WF (2002) Non-surgical management of spinal cord injury. Expert Opin Investig Drugs 11:469–482

    CAS  PubMed  Google Scholar 

  11. Lonstein JE, Winter RB, Moe JH, Bradford S,Chou SN, Pinto WC (1980) Neurologic deficits. Secondary to spinal deformity. A review of the literature and report of 43 cases. Spine 5:4

    PubMed  Google Scholar 

  12. Mayr MT, Subach BR, Comey CH et al (2002) Cervical spinal stenosis: outcome after anterior corporectomy, allograft reconstruction, and instrumentation. J Neurosurg 96 [Supp1]:10–16

    Google Scholar 

  13. McEwen GD, Bunnell WP, Sriram K (1975) Acute neurological complications in treatment of scoliosis. A report of the scoliosis research society. J Bone Joint Surg Am 57:404–408

    PubMed  Google Scholar 

  14. McMaster MJ, Singh H (1999) Natural history of congenital kyphosis and kyphoscoliosis. A study of one hundred and twelve patients. J Bone Joint Surg Am 81:1367–1383

    CAS  PubMed  Google Scholar 

  15. Meinecke FW (1988) Rückenmarksschäden im Gefolge von Diagnostik und Therapie. Unfallchirurg 91:270–277

    CAS  PubMed  Google Scholar 

  16. Metz-Stavenhagen P, Krebs S, Völpel HJ (2001) Operationsmethoden zur Behandlung der Totalkyphose bei der Spondylitis ankylosans. Orthopäde 30:988–995

    Google Scholar 

  17. Otani K, Abe H, Kadoya S et al (1994) Beneficial effect of methylprednisolone sodium succinate in the treatment of acute spinal cord injury. Sekirsu Sekizui 7:633–647

    Google Scholar 

  18. Pascal-Moussellard H, Broc G, Pointillart V et al (1998) Complications of vertebral metastasis surgery. Eur Spine J 7:438–444

    Article  CAS  PubMed  Google Scholar 

  19. Pointillart V, Petitjean ME, Wiart L et al (2000) Pharmacological therapy of spinal cord injury during the acute phase. Spinal Cord 38:71–76

    Google Scholar 

  20. Poynton AR, O’Farell DA, Shannon F et al (1997) An evaluation of the factors affecting neurological recovery following spinal cord injury. Injury 28:545–548

    Article  CAS  PubMed  Google Scholar 

  21. Takahashi S, Delecrin J, Passuti N (2001) Intraspinal metallosis causing delayed neurologic symptoms after spinal instrumentation surgery. Spine 26:1495–1498

    Article  CAS  PubMed  Google Scholar 

  22. Wada E, Suzuki S, Kanazawa A et al (2001) Subtotal corporectomy versus laminoplasty for multilevel cervical spondylotic myelopathy. A long-term follow-up study over 10 years. Spine 26:1443–1448

    Article  CAS  PubMed  Google Scholar 

  23. Wilkins C, McEwen GD (1977) Cranial nerve injury from halo traction. Clin Orthop 126:106–110

    PubMed  Google Scholar 

  24. Winter RB, Moe JH, Lonstein JE (1985) The surgical treatment of congenital kyphosis. A review of 94 patients age 5 years or older, with 2 years or more follow-up in 77 patients. Spine 10:224–231

    Google Scholar 

  25. Wise JJ, Fischgrund JS, Herkowitz HN et al (1999) Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. Spine 15:1943–1951

    Article  Google Scholar 

  26. Zielke K, Pellin B (1975) Das neurologische Risiko der Harrington-Operation. Arch Orthop Unfall Chir 83:311–322

    Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Cologne, Joseph-Stelzmannstraße 9, 50931, Cologne, Germany

    K.-S. Delank, H. W. Delank, D. P. König, F. Popken, S. Fürderer & P. Eysel

  2. Dahlhauserstraße 77a, 45529, Hattingen, Germany

    H. W. Delank

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  1. K.-S. Delank
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  2. H. W. Delank
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  3. D. P. König
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  4. F. Popken
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  5. S. Fürderer
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  6. P. Eysel
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Correspondence to K.-S. Delank or H. W. Delank.

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Delank, KS., Delank, H.W., König, D.P. et al. Iatrogenic paraplegia in spinal surgery. Arch Orthop Trauma Surg 125, 33–41 (2005). https://doi.org/10.1007/s00402-004-0763-5

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  • DOI: https://doi.org/10.1007/s00402-004-0763-5

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