Lei Yuan1,2,3, Zhongqiang Chen4,5,6, Weishi Li1,2,3, Chuiguo Sun1,2,3, Zhongjun Liu1,2,3, Xiaoguang Liu1,2,3. 1. Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Hai Dian District, Beijing, 100191, China. 2. Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, No. 49 North Garden Road, Beijing, 100191, China. 3. Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, No. 49 North Garden Road, Beijing, 100191, China. 4. Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Hai Dian District, Beijing, 100191, China. zqchenby@163.com. 5. Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, No. 49 North Garden Road, Beijing, 100191, China. zqchenby@163.com. 6. Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, No. 49 North Garden Road, Beijing, 100191, China. zqchenby@163.com.
Abstract
PURPOSE: Post-operative neurological deterioration (ND) is a severe complication. However, limited literature exists on the ND in thoracic disc disorders with myelopathy (TDM). This study describes the risk factors of neurological deterioration in TDM with instrumentation and fusion. METHODS: A single-centre review of TDM with instrumentation and fusion during 2006-2019 was performed. Post-operative neurological deterioration was defined as the deterioration of pre-existing neurological function or the appearance of new neurological symptoms. Patients were then grouped into two groups depending on neurological deterioration (ND group) or not (non-ND group). Demographics, radiographic parameters, and surgical characteristics were compared between the two groups. RESULTS: A total of 257 cases were included, and neurological deterioration occurred in 16 (6.23%) cases. Multivariate analysis revealed spinal canal occupancy ratio > 75%, U-shaped compressed spinal cord in axial MRI, calcified herniated disc, anterior approach, and intra-operative blood loss > 1500 mL were associated with ND. Ten patients (62.5%) had complete neurological recovery within six months, and four patients (25%) had progressive neurological function improvement and equal or better than pre-operation within nine months. CONCLUSIONS: The rate of neurological deterioration is 6.23%, and a higher spinal canal occupancy ratio, U-shaped compressed spinal cord, calcified herniated disc, anterior approach, and massive intra-operative blood loss were associated with neurological deterioration. Long-term outcomes of neurological deterioration are favourable, and 62.5% of patients experienced complete neurological recovery within six months. Patients with TMD who undergo surgery should be properly informed of the potential risks of neurological deterioration, despite its usually transient nature in most patients.
PURPOSE: Post-operative neurological deterioration (ND) is a severe complication. However, limited literature exists on the ND in thoracic disc disorders with myelopathy (TDM). This study describes the risk factors of neurological deterioration in TDM with instrumentation and fusion. METHODS: A single-centre review of TDM with instrumentation and fusion during 2006-2019 was performed. Post-operative neurological deterioration was defined as the deterioration of pre-existing neurological function or the appearance of new neurological symptoms. Patients were then grouped into two groups depending on neurological deterioration (ND group) or not (non-ND group). Demographics, radiographic parameters, and surgical characteristics were compared between the two groups. RESULTS: A total of 257 cases were included, and neurological deterioration occurred in 16 (6.23%) cases. Multivariate analysis revealed spinal canal occupancy ratio > 75%, U-shaped compressed spinal cord in axial MRI, calcified herniated disc, anterior approach, and intra-operative blood loss > 1500 mL were associated with ND. Ten patients (62.5%) had complete neurological recovery within six months, and four patients (25%) had progressive neurological function improvement and equal or better than pre-operation within nine months. CONCLUSIONS: The rate of neurological deterioration is 6.23%, and a higher spinal canal occupancy ratio, U-shaped compressed spinal cord, calcified herniated disc, anterior approach, and massive intra-operative blood loss were associated with neurological deterioration. Long-term outcomes of neurological deterioration are favourable, and 62.5% of patients experienced complete neurological recovery within six months. Patients with TMD who undergo surgery should be properly informed of the potential risks of neurological deterioration, despite its usually transient nature in most patients.
Authors: Juan S Uribe; William D Smith; Luiz Pimenta; Roger Härtl; Elias Dakwar; Urvij M Modhia; Glen A Pollock; Vamsi Nagineni; Ryan Smith; Ginger Christian; Leonardo Oliveira; Luis Marchi; Vedat Deviren Journal: J Neurosurg Spine Date: 2011-12-16