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The prognosis and risk factors analysis of major neurological complications in spinal deformity correction surgery / 中华骨科杂志
Chinese Journal of Orthopaedics ; (12): 815-824, 2021.
Article in Chinese | WPRIM | ID: wpr-910663
ABSTRACT

Objective:

To analyze the natural history and outcomes of major neurological complications in spinal deformity correction surgery and to determine the risk factors for no neurological recovery.

Methods:

All of 7 851 patients with spinal deformity who underwent deformity correction from January 2000 to December 2017 were reviewed. Major neurological complication featured by complete or incomplete paralysis of single or both lower extremities was identified in 59 patients, including 28 males and 31 females with an average age of 25.0±16.3 (range 6 to 71 years old). Among these cases, 6 were adolescent idiopathic scoliosis, 22 were congenital scoliosis, 10 were neuromuscular scoliosis, 5 were neurofibromatosis type 1, and 16 were other types. 5 patients had complete paraplegia of the lower limbs, 17 patients had incomplete paralysis of the lower limbs, and 37 patients had incomplete paraplegia of unilateral lower limb. Treatment included implant removal, debridement of hematoma, loosening the fixation and decompression by laminectomy for mechanical injury, as well as transfusion and press agent for ischemic injury. The neurological function was determined by the American Spinal Injury Association (ASIA) grading system.Fisher exact test and univariate logistics regression were used to determine the association between clinical, surgical parameters and no recovery of neurological function. For the identified factors with P value<0.10, multiple logistics regression was used to determine the independent risk factor for no recovery.

Results:

The incidence of major neurological complications was 0.75%(59/7851). At final follow-up, 42 patients (71.2%) had complete recovery and 10 patients (16.9%) had partial recovery, and 44 cases (74.6%) had recovery within 6 months. There were 7 cases had no recovery, including 3 with type I neurofibromatosis(ASIA 1 grade A, 2 grade C), 1 with Scheuermann's disease (ASIA grade C), 1 with arthrogryposis multiplex congenital (ASIA grade B), 1 with poliomyelitis related scoliosis (ASIAgrade C), and 1 with idiopathic scoliosis (ASIA grade A). Fisher test showed the distribution of etiology was statistically different between recovery and no recovery groups. Univariate logistics regression showed diagnosis as NF-1 ( OR=18.750, P=0.005), Cobb angle of the main curve >90° ( OR=4.444, P=0.073), preoperative deficit ( OR=5.750, P=0.046) and complete neurological injury ( OR=6.533, P=0.067) were potential risk factors for no recovery. Multivariate logistics regression showed that diagnosis with NF-I ( OR=35.477, P=0.005) was the risk factor for no recovery.

Conclusion:

For patients who underwent deformity correction that develops major neurological complications after surgery, 88.1% of patients were able to recover during follow-up, and 71.2% of patients achieved complete recovery. The first 3-6 month is the time window for neurological recovery. Patients with type I neurofibromatosis is the risk factor for no recovery.

Full text: Available Index: WPRIM (Western Pacific) Type of study: Etiology study / Prognostic study / Risk factors Language: Chinese Journal: Chinese Journal of Orthopaedics Year: 2021 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Type of study: Etiology study / Prognostic study / Risk factors Language: Chinese Journal: Chinese Journal of Orthopaedics Year: 2021 Type: Article