Spinal cord injury in high-risk complex adult spinal deformity surgery: review of incidence and outcomes from the Scoli-RISK-1 study

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2024年8月17日

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Fan Jiang,
Hetshree Joshi,
Jetan H. Badhiwala,
Jamie R. F. Wilson,
Lawrence G. Lenke,
Christopher I. Shaffrey,
Kenneth M. C. Cheung,
Leah Y. Carreon,
Mark B. Dekutoski,
Frank J. Schwab,
Oheneba Boachie-Adjei,
Khaled M. Kebaish,
Christopher P. Ames,
Sigurd H. Berven,
Yong Qiu,
Yukihiro Matsuyama,
Benny T. Dahl,
Hossein Mehdian,
Ferran Pellisé,
Stephen J. Lewis,
Michael G. Fehlings

摘要

Study design

Clinical case series.

Objective

To describe the cause, treatment and outcome of 6 cases of perioperative spinal cord injury (SCI) in high-risk adult deformity surgery.

Setting

Adult spinal deformity patients were enrolled in the multi-center Scoli-RISK-1 cohort study.

Methods

A total of 272 patients who underwent complex adult deformity surgery were enrolled in the prospective, multi-center Scoli-RISK-1 cohort study. Clinical follow up data were available up to a maximum of 2 years after index surgery. Cases of perioperative SCI were identified and an extensive case review was performed.

Results

Six individuals with SCI were identified from the Scoli-RISK-1 database (2.2%). Two cases occurred intraoperatively and four cases occurred postoperatively. The first case was an incomplete SCI due to a direct intraoperative insult and was treated postoperatively with Riluzole. The second SCI case was caused by a compression injury due to overcorrection of the deformity. Three cases of incomplete SCI occurred; one case of postoperative hematoma, one case of proximal junctional kyphosis (PJK) and one case of adjacent segment disc herniation. All cases of post-operative incomplete SCI were managed with revision decompression and resulted in excellent clinical recovery. One case of incomplete SCI resulted from infection and PJK. The patient’s treatment was complicated by a delay in revision and the patient suffered persistent neurological deficits up to six weeks following the onset of SCI.

Conclusion

Despite the low incidence in high-risk adult deformity surgeries, perioperative SCI can result in devastating consequences. Thus, appropriate postoperative care, follow up and timely management of SCI are essential.