Neurological complications in treatment of severe thoracolumbar spinal deformity with one stage posterior vertebral column resection

Abstract

Objective To analyze the neurological complications in treatment of severe thoracolumbar spinal deformity with one stage posterior vertebral column resection （pVCR） and discuss the related risk factors. Methods There were 67 patients with severe thoracolumbar spinal deformity who underwent one-stage pVCR from February 2000 to September 2010. There were 29 males and 38 females at an average age of 31.4 years old （range, 14-62 years）. There were 21 patients at age less than 18 years old and 46 at age more than 18 years old. Patients were divided into four pathological types： severe scoliosis group （n=11, mean Cobb angle 90.4°）, kyphoscoliosis group （n =25, mean scoliosis 94.5°, and mean kyphosis 65.5°）, angular kyphosis group （n = 28, mean kyphosis 74.3°） and global kyphosis group （n = 3, mean kyphosis 91. 1°）. Of all the patients, 59 patients underwent primary surgery and eight underwent revision surgery. Surgical methods included posterior apex vertebral column resection, segemental pedicle screw fixation and correction as well as 360° bone fusion. Neurological complication was statistically analyzed. Results The average follow-up was 14 months （range, 3-69 months ）, which showed severe neurologic complication in eight patients （ 11.9% ） after surgery. Severe neurologic complication occurred in three patients （4.5%）, among whom one patient presented delayed complete paraplegia 23 hours after surgery. Five p~ients had mild neuJ：ologic deficits （7.5 % ） , the incidence of which was higher than 23.1% for thoracic osteotomy （P 〈 0.05）. Multilevel pVCR had high rate of neurological complications （P 〈 0.05 ）. The incidence rate was 33.3% for patients with preoperative neurologic compromise and 7.3% for patients without preoperative neurologic compromise （ P 〈0.05 ）. The incidence rate was increased in the revision surgery （P 〈 0. 05）. Eight patients with neurological deficits had kyphotic angle of more than 60° although there was no statistical difference （ P 〉 0.05 ）. Conclusions pVCR is an effective surgical method for the correction of severe thoracolumbar spinal deformity. The neurological complications, however, should be paid attention to the surgeons. The risk factors for neurologic complications include improper manipulation, massive blood losing, preoperative neurologic compromise, osteotomy at thoracic region, multi-level vertebrectomy, revision surgery and severe kyphosis. Key words: Scoliosis ;  Kyphosis ;  Osteotomy ;  Vertebral column resection