TY - JOUR
T1 - Spinal cord injury in high-risk complex adult spinal deformity surgery
T2 - review of incidence and outcomes from the Scoli-RISK-1 study
AU - Jiang, Fan
AU - Joshi, Hetshree
AU - Badhiwala, Jetan H.
AU - Wilson, Jamie R.F.
AU - Lenke, Lawrence G.
AU - Shaffrey, Christopher I.
AU - Cheung, Kenneth M.C.
AU - Carreon, Leah Y.
AU - Dekutoski, Mark B.
AU - Schwab, Frank J.
AU - Boachie-Adjei, Oheneba
AU - Kebaish, Khaled M.
AU - Ames, Christopher P.
AU - Berven, Sigurd H.
AU - Qiu, Yong
AU - Matsuyama, Yukihiro
AU - Dahl, Benny T.
AU - Mehdian, Hossein
AU - Pellisé, Ferran
AU - Lewis, Stephen J.
AU - Fehlings, Michael G.
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
U2 - 10.1038/s41394-024-00673-y
DO - 10.1038/s41394-024-00673-y
M3 - Journal article
C2 - 39153987
AN - SCOPUS:85201380624
SN - 2058-6124
VL - 10
JO - Spinal cord series and cases
JF - Spinal cord series and cases
IS - 1
M1 - 59
ER -