[Analysis of neurological deficits complications in the treatment of spinal deformity with posterior spinal osteotomy].
OBJECTIVE
To investigate the incidence and causes of neurologic deficits complications in the treatment of spinal deformity with posterior spinal osteotomy.


METHODS
From January 2007 to December 2010, 321 cases of scoliosis or kyphosis patients were treated with posterior spinal osteotomy. There were 124 male and 197 female with an average age of (19 ± 11) years (2 - 56 years). The average preoperative main Cobb angle was 108° ± 33° (48° - 175°), the average kyphotic angle was 74° ± 29° (53° - 170°) before operation. Pedicle subtraction osteotomy was used in 226 cases, 95 cases with vertebral column resection. Pedicle screw-rod system was used for fixation. The patients were monitored by Somatosensory-evoked potentials monitoring and Stagnara wake-up test.


RESULTS
There were 11 cases with varying degrees of new neurologic deficits and the total incidence was 3.4%. The causes were as followed, spinal translation in 2 cases, compromised by close of resected areas in 2 cases, residual bone compression in 1 case, inadvertent operation in 2 cases, screw malposition in 1 case, hematoma compression in 1 case and spine elongation in 2 cases. There was significant difference between the patients with preexisting neurologic deficits (20.0%) and the patients with intact neurologic function (2.6%) (χ(2) = 13.060, P = 0.011), no significant differences in different classes of the age, etiology, deformity, osteotomy type and surgical type (P > 0.05). But the incidence of neurologic deficits was 4.6% in congenital scoliosis, 7.1% in neuromuscular scoliosis, 5.1% in kyphosis, 5.9% in adult deformity and 5.9% in Cobb angle more than 100°, which was higher than other classes. All the 11 cases were given emergent Methylprednisolone, neurotrophic drugs and hyperbaric oxygen therapy, 4 cases were underwent surgical exploration again. After treatment, 7 cases recovered completely, 2 cases recovered partially and 2 cases failed to improve at the last follow-up.


CONCLUSIONS
Severe spinal deformity could be effectively treated with posterior spinal osteotomy. But the procedure is technical demanding and risky for neurologic deficits. The high risk factor is preexisting neurologic deficits.
Department of Orthopaedic Surgery, Spinal Surgery Center of People's Liberation Army, the 306th Hospital, Beijing 100101, China. mh306h@yahoo.com.cn
Hua-song
HS
Ma
Zhi-ming
ZM
Chen
Bin
B
Yang
Ji-gong
JG
Wu
Rong
R
Tan
Xiao-ping
XP
Wang
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D055815:Young Adult