Operative neurological complications resulting from thoracic and lumbar spine internal fixation.
Of 2023 patients treated for acute spinal injuries, 729 sustained acute injuries in thoracic and lumbar regions; 295 surgically treated patients were reviewed for evidence of postoperative neurological complications. Of the 295 patients, 150 were intraoperatively monitored using somatosensory-evoked potentials (SSEP). Six patients (4%) revealed intraoperative deterioration of the SSEP; however, only one of the six revealed a new postoperative neurological deficit (0.7%). The remaining 145 patients were included in the unmonitored or wake-up test group in which ten (6.9%) demonstrated new postoperative deficits. Of the 11 patients with new postoperative neurological deficits, eight patients demonstrated motor weakness, two had radiculopathy, and one had bowel-bladder incontinence. The intraoperative use of SSEP was not able to identify subtle alterations in neurological function; however, due to early warning, SSEP appears capable of preventing profound surgically induced neurological alterations. A new protocol is designed for the management of intraoperative neurological deterioration as detected by SSEP.
Meyer
P R
PR
Northwestern University Medical School, IL.
Cotler
H B
HB
Gireesan
G T
GT
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis*; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009422:Nervous System Diseases / Q000209:etiology; D009984:Orthopedic Fixation Devices / Q000009:adverse effects; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery*