Surgical treatment of severe spinal deformity combined with neurological deficits

LI Yan-ning; MENG Xiang-long; HAI Yong

doi:10.3969/j.issn.2095-252X.2014.12.006

Abstract：Objective To evaluate the clinical outcomes of surgical treatment of severe spinal deformity combined with neurological deifcits through a posterior approach. Methods A retrospective study on 14 patients with severe spinal deformity combined with neurological deifcits who were treated by posterior surgery was performed. Etiologic diagnoses were congenital in 9 cases, neurofibromatosis in 2 cases, idiopathic in 1 case, tuberculous in 1 case and degenerative in 1 case. Two patients had prior spinal surgeries. The average preoperative Cobb’s angles of scoliosis and kyphosis were 98.4° ( range:53°-150° ) and 104° ( range:48°-151° ) respectively. According to the Frankel grading system, the preoperative neurological function was rated as grade B in 2 cases, grade C in 3 cases and grade D in 9 cases. Pedicle subtraction osteotomy ( PSO ) was performed on 4 patients, posterior vertebral column resection ( PVCR ) on 1 patient, hemivertebra resection on 1 patient, laminectomy and internal ifxation on 4 patients, posterior internal ifxation on 2 patients and revision on 1 patient. And 1 patient underwent ifxation removal surgery. The neurological function in half of the 14 patients were detected by somatosenory-evoked potential ( SEP ) monitoring and all the patients underwent the wake-up test during the surgery. Results The average follow-up period was 36.6 months ( range: 12-69 months ). The average postoperative Cobb’s angles of scoliosis and kyphosis were 55° ( range:5°-100° ) and 62.1° ( range:25°-92° ), with the average correction rates of 44.1%and 40.2%and the average losses of correction of 1.7° and 4.8°. Five of the 7 patients with SEP monitoring had no reliable SEP waves intraoperatively. The neurological symptoms got worse postoperatively in 5 patients and the total incidence was 35.7%.Three of them got improved after the treatment of emergent methylprednisolone and neurotrophic drugs and hyperbaric oxygen therapy. In the latest follow-up, the neurological function was improved in 11 patients ( 78.6%), not improved in 1 patient ( 7.1%) and worse in 2 patients ( 14.3%). Conclusions The neurological function of the patients with severe spinal deformity combined with neurological deifcits can be effectively improved after surgical treatment. But the deformity of these patients is severe and many patients have no reliable SEP waves intraoperatively. So it is dififcult to ifnd spinal cord injuries at an early stage, and the neurological function may get worse postoperatively.