title: Major intraoperative neurologic deficits in pediatric and adult spinal deformity patients. Incidence and etiology at one institution.
abstract: METHODS
  A retrospective study of 1,090 patients undergoing corrective spinal deformity surgery for scoliosis (n = 920), kyphosis (n = 77), or a combination of the two (n = 93) at one institution.
  
  
  OBJECTIVE
  To ascertain the etiologies and incidence of neurologic deficits occurring at the time of surgery.
  
  
  BACKGROUND
  Potential etiologies of intraoperative neurologic deficits include cord compression, overdistraction, purely vascular, or a combination.
  
  
  METHODS
  The study group included only patients with useful function of their lower extremities and normal bowel and bladder control, and patients whose surgeries were in spinal cord territory as opposed to purely cauda equina territory.
  
  
  RESULTS
  There were four major neurologic deficits that occurred during surgery. Three of the four deficits were purely vascular in etiology. The fourth may have had a vascular and mechanical etiology. All four patients had anterior and posterior surgery with harvesting of the unilateral convex segmental vessels, and each had a component of hyperkyphosis, as well as intraoperative controlled hypotension. All four patients showed marked improvement of motor weakness with time.
  
  
  CONCLUSIONS
  Significant risk factors were combined anterior and posterior surgery (P = 0.009) and hyperkyphosis (P = 0.0006).
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: K H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: L G
authors.initials: LG
authors.lastname: Lenke
authors.forename: C
authors.initials: C
authors.lastname: Baldus
authors.forename: K
authors.initials: K
authors.lastname: Blanke
mesh_terms: D000293:Adolescent; D000328:Adult; D001808:Blood Vessels / Q000293:injuries; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology*; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology*; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013116:Spinal Cord / Q000098:blood supply; D013117:Spinal Cord Compression / Q000453:epidemiology / Q000209:etiology
chemical_list: D008775:Methylprednisolone