title: Neurological complications of thoracic posterior vertebral column resection for severe congenital spinal deformities.
abstract: The risk of neurological injury during vertebral column resection is high. In this study, we investigated the incidence and risk factors for neurological complications when treating spinal deformities by thoracic posterior vertebral column resection (PVCR).
  
  
  
  Between 2008 and 2013, there were 62 consecutive patients (34 female patients and 28 male; the mean age: 16.3 years, range 6-46 years) treated with thoracic PVCR. We retrospectively reviewed the clinical records to obtain demographic and radiographic data, operative time, estimated blood loss (EBL, the ratio between circulating and lost blood), bleeding volume (the lost blood), number of vertebrae fused, number of vertebrae resected, usage of titanium mesh cage, and intraoperative neuromonitoring data. Multi-factor logistic regression was used to find the major risk factors for neurological complications.
  
  
  
  The average follow-up period was 46 months (range 24-88 months); no patients were lost to follow up. The average operative time was 524.8 ± 156.8 min (range 165.0-880.0 min), the average bleeding volume was 2585 ± 2210 ml (100-9600 ml), and the average estimated blood loss was 75.8% (9-278%). Ten patients (16.1%) developed post-operative neurological complications (nine transient and one permanent). Multi-factor logistic regression revealed that the risk factors for neurological complications were age ≥18 years, pulmonary dysfunction, and EBL >50%.
  
  
  
  Thoracic PVCR can lead to satisfactory outcomes in the treatment of severe spinal deformities. Risk factors for neurological complications include the age over 18 years, presence of pulmonary dysfunction, and EBL greater than 50%. The pulmonary dysfunction can be regarded as the most valuable indicator to measure the severity of the spine deformity.
authors.affiliation: Department of Orthopaedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710032, China.|Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China.
authors.forename: Bo-Bo
authors.initials: BB
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, The Hospital of Xin Jiang Production and Construction Corps, Urumqi, 830002, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710032, China. huiren_tao@163.com.|Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China. huiren_tao@163.com.
authors.forename: Hui-Ren
authors.initials: HR
authors.lastname: Tao
authors.affiliation: Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China.
authors.forename: Tai-Lin
authors.initials: TL
authors.lastname: Wu
authors.affiliation: Department of Orthopaedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710032, China.
authors.forename: Chun-Guang
authors.initials: CG
authors.lastname: Duan
authors.affiliation: Department of Orthopaedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710032, China.
authors.forename: Wei-Zhou
authors.initials: WZ
authors.lastname: Yang
authors.affiliation: Department of Orthopaedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710032, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China.
authors.forename: Wen-Rui
authors.initials: WR
authors.lastname: Ma
authors.affiliation: Department of Orthopaedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710032, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Su
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000151:congenital / Q000601:surgery*; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000209:etiology*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Neurological complication; Posterior vertebral column resection; Pulmonary function; Scoliosis; Spinal deformity