title: Perioperative Neurologic Injury Associated With Rib-Based Distraction Surgery.
abstract: METHODS
  Retrospective, comparative case series from the study group database.
  
  
  OBJECTIVE
  The primary objective was to report the neurologic injury rate for rib-based distraction surgery and determine whether preoperative diagnosis affects this rate. The secondary objective was to describe these injuries and outcome.
  
  
  BACKGROUND
  Posterior distraction-based systems are commonly used to treat early-onset scoliosis. General complication rates for these surgeries are high; however, there are few reports in the literature on neurologic injury after rib-based distraction surgery.
  
  
  METHODS
  This was a retrospective review of the Children's Spine Study Group database from 2004 to 2013. The researchers used the chi-square test to compare the distributions of proportions between diagnoses.
  
  
  RESULTS
  A total of 524 patients were identified and treated with rib-based distraction surgery. The preoperative diagnoses consisted of 222 congenital/structural, 163 neuromuscular, 63 syndromic, 67 idiopathic, and 9 unknown. There were 9 neurologic injuries (7 clinical and 2 neuromonitoring alerts) for a neurologic injury rate of 1.7%. Using the Classification for Early-Onset Scoliosis, 8 patients were classified as congenital and 1 as neuromuscular. The neurologic injury rate in the congenital curves group was 3.6% and was 0.34% in non-congenital curves (p = .005). The proportion of injured patients with an additional secondary diagnosis was 3.82%, compared with 0.82% patients with only a primary diagnosis (p = .01). Eight injuries occurred at initial implantation and 1 at revision surgery. Most were brachial plexus (n = 5) with no complete spinal cord injuries. Four patients required return to surgery and 1 needed intraoperative intervention. At 4.2 years' follow-up, 7 of 9 patients had full resolution of symptoms and 2 patients had residual upper extremity weakness.
  
  
  CONCLUSIONS
  The rate of neurologic injury for patients treated with rib-based distraction surgery was 1.7%. Most injuries occurred with congenital diagnoses and they were more likely in patients with additional secondary diagnoses. These injuries were predominantly to the brachial plexus and generally resolved.
authors.affiliation: Division of Orthopaedic Surgery, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax NS, Nova Scotia B3K 6R8, Canada.
authors.forename: Luke E
authors.initials: LE
authors.lastname: Gauthier
authors.affiliation: Division of Orthopaedic Surgery, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax NS, Nova Scotia B3K 6R8, Canada.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Mandourah
authors.affiliation: Division of Orthopaedic Surgery, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax NS, Nova Scotia B3K 6R8, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Soroceanu
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, Gonda Bldg 14 Fl, 200 First St. SW, Rochester, MN 55905, USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: McIntosh
authors.affiliation: Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Wood Bldg 2nd Fl, 34th & Civic Center Blvd, Philadelphia, PA 19104, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Flynn
authors.affiliation: Division of Orthopaedic Surgery, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax NS, Nova Scotia B3K 6R8, Canada. Electronic address: Ron.El-Hawary@iwk.nshealth.ca.
authors.forename: Ron
authors.initials: R
authors.lastname: El-Hawary
keywords: Early-onset scoliosis; Neurologic complication; Rib-based posterior distraction; Vertical Expandable Prosthetic Titanium Rib