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Neurological complications of thoracic posterior vertebral column resection for severe congenital spinal deformities

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Abstract

Purpose

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).

Methods

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.

Results

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%.

Conclusions

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.

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Acknowledgements

Science and technology innovation project in Shaanxi Province of China (Grant No. 2015KTCL03-09), Natural Science Foundation of China (Grant No. 81070698), Natural Science Basic Research Plan in Shaanxi Province of China (Grant No. 2015JM8411), and The youth development project of the army medical technology (Grant No. 13QNP130) funds were received to support this work. No relevant financial activities outside the submitted work.

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Author notes

  1. Bo-bo Zhang, Tao Zhang, and Tai-lin Wu contributed equally to this work and should be considered as co-first authors.

Authors and Affiliations

  1. Department of Orthopaedics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710032, China

    Bo-bo Zhang, Hui-ren Tao, Chun-guang Duan, Wei-zhou Yang, Tao Li & Wei Su

  2. Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032, China

    Bo-bo Zhang, Hui-ren Tao, Tai-lin Wu, Feng Li, Ming Liu & Wen-rui Ma

  3. Department of Orthopaedics, The Hospital of Xin Jiang Production and Construction Corps, Urumqi, 830002, China

    Tao Zhang

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  1. Bo-bo Zhang
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  2. Tao Zhang
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Corresponding author

Correspondence to Hui-ren Tao.

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All authors declared that there was no potential conflict of interest.

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Zhang, Bb., Zhang, T., Tao, Hr. et al. Neurological complications of thoracic posterior vertebral column resection for severe congenital spinal deformities. Eur Spine J 26, 1871–1877 (2017). https://doi.org/10.1007/s00586-017-5061-3

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  • DOI: https://doi.org/10.1007/s00586-017-5061-3

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