title: The effect from different numbers of segmental arteries ligation to the spinal cord in the clinical practice of posterior vertebral column resection correction.
abstract: In using posterior vertebral column resection (PVCR) to treat severe kyphoscoliosis, it is unavoidable to ligate and cut off several segmental arteries (SAs) of the spinal cord for exposure and hemostasis, but which would raise the neurological risks. The aim of this study is to explore the changes of intraoperative spinal cord monitoring (IOM) following ligating different numbers of SAs in PVCR.
  
  
  
  Twenty-one consecutive patients with severe kyphoscoliosis were included and treated by PVCR correction. In operation, according to ligate different numbers of SAs, the IOM changes were recorded, respectively. Examinations of the covariance between different numbers of SAs ligations and IOM changes were performed to reveal the effect to the spinal cord by SAs ligations.
  
  
  
  In all the 21 cases, averaging 1.9 pairs of SAs were ligated. With the increased numbers of ligations, SSEP amplitudes and latencies were changed more obviously: from 1 to 3 pairs ligations, the mean decreased percentages of amplitudes were from 53.20 to 78.15%, the mean increased percentages of latency were from 1.23 to 1.40%, and the mean durations of decreased SSEP amplitudes were from 3.23 to 5.2 min; but without abnormal MEP changes. None occurred postoperative or delayed neurological deficit. Correlation analysis identified significant correlations between the number of SAs ligation and decreased percentage of SSEP amplitude (r = 0.945, P < 0.0001), and between the number of SAs being ligated and the duration of SSEP change (r = 0.945, P = 0.0002).
  
  
  
  Following the increased number of SAs ligation, the amplitude of SSEP is decreased more obviously with a much longer duration of recovery and the risk to spinal cord will be increased greatly. In the PVCR correction on the basis of spinal shortening, the numbers of SAs ligations should be as less as possible for neurological safety.
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, Yunnan Province, 650101, People's Republic of China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, Yunnan Province, 650101, People's Republic of China. xiejingming@vip.163.com.
authors.forename: Jingming
authors.initials: J
authors.lastname: Xie
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, Yunnan Province, 650101, People's Republic of China.
authors.forename: Yingsong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, Yunnan Province, 650101, People's Republic of China.
authors.forename: Ni
authors.initials: N
authors.lastname: Bi
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, Yunnan Province, 650101, People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, Yunnan Province, 650101, People's Republic of China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, Yunnan Province, 650101, People's Republic of China.
authors.forename: Zhiyue
authors.initials: Z
authors.lastname: Shi
mesh_terms: D000293:Adolescent; D000328:Adult; D001158:Arteries / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D007738:Kyphosis / Q000150:complications / Q000601:surgery*; D008026:Ligation; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D013116:Spinal Cord / Q000098:blood supply* / Q000503:physiopathology; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Intraoperative monitoring; Posterior vertebral column resection; Segmental artery ligation; Spinal cord