P31. Intraoperative complications and neurologic changes following posterior thoracic corpectomies via a costotransversectomy type approach

Abstract

BACKGROUND CONTEXT Iatrogenic cord injuries, dural tears, and pleural injuries are operative risks associated with thoracic corpectomies via costotransversectomy approaches (TCCA). Few studies have comprehensively described the rates of intra-operative complications including motor score changes, intraoperative neuromonitoring changes, dural tears, and pleural injuries. PURPOSE We seek to describe the rates and sequelae of changes to lower extremity motor score (LEMS), neuromonitoring signal changes, dural tears and pleural injuries in patients undergoing TCCA. STUDY DESIGN/SETTING Retrospective chart review conducted at a single academic referral center. PATIENT SAMPLE A total of 118 consecutive patients undergoing TCCA over a 10-year period with documented preoperative and post-operative motor examinations. OUTCOME MEASURES Outcomes included documented LEMS (out of 50) and intraoperative neuromonitoring changes. Pleural and dural injuries and subsequent treatment were assessed. METHODS Data were retrospectively collected from operative notes, intraoperative neuromonitoring reports, and the post-operative inpatient and outpatient clinical notes. Preoperative LEMS greater than or equal to 48 were considered intact. Post-operative LEMS were categorized into improved, unchanged or lower as compared to the preoperative scores. Categorical data was assessed with the Fisher's Exact test. Significance was set at p=0.05. RESULTS Lower extremity motor scores: Of the 118 patients, 68 were intact pre-operatively and 50 were not intact. Four percent of non-intact patients demonstrated a declining post-operative examination as compared to 14.7% of intact patients (p CONCLUSIONS Most patients undergoing TCCA procedures have unchanged or improved LEMS by discharge. Approximately 10% of patients had an initial decline in their LEMS with less than 3% of patients demonstrating lasting decline in neurologic status at final follow-up. Most neuromonitoring changes occurred at the time of corpectomy or graft/cage placement. Intraoperative pleural and dural injures during these procedures generally only require simple routine treatment. This information can be valuable in counseling patients regarding the risk of neurologic outcome, dural tear, and pleural injury following TCCA. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.