Abstract
Study Design
This study is a retrospective descriptive study, and Evidence Level IV.
Objective
This study aims to assess the evolution of neurological complications because of kyphosis or scoliosis surgery in children.
Introduction
Neurological complications after deformities surgery although not very frequent could be evolved in terrific outcomes. These can come after simple approach, instrumentation, and because of correction techniques through direct or indirect mechanism. Modern surgeries techniques count with neurophysiology monitoring. Nonetheless, radicular and spinal cord injury may arise.
Patients and Methods
Nine patients who suffered neurological complication during kyphosis and/or scoliosis deformity surgery from May 2003 to June 2013 at the Garrahan Pediatric Hospital Spine Department.
Results
Etiologies observed were as follows: four idiopathic scoliosis (44.4%), two congenital scoliosis (22.2%), one associated with neurofibromatosis type I (11%), one idiopathic kyphosis (11%), and one myofibrosarcomatosis post laminectomy surgery (11%). The mean follow-up was 4.3 years (range, 0.6–10.5 years). We performed posterior only instrumented fusion in seven cases (77.7%) and two double approach instrumented fusions (22.3%). Five patients presented intraoperative neurological changes (55.5%). All the patients needed at least a second surgical intervention to solve the spine deformity. The topographic classification of the neurological injury was as follows: one patient with radicular injury (11.1%); eight patients with spinal cord injury (88.8%), six of those presented bilateral paresis (75%) and two patients (25%) presented monoparesis. The patient with radicular injury remained asymptomatic after the second-staged surgery; three patients remained with minimum secuelas (ASIA D) and three patients, with major disability secuelas (ASIA C), all patients preserved aptitude to stroll. Four patients (44.4%) who presented disorders in the sphincters control during the immediate postoperatory, only two patients stayed with neurogenic bladder.
Conclusion
Early detection of a neurological complication, its etiological diagnosis, and surgical resolution improve neurological outcome of the patient, avoiding or reducing its severity sequel.