New Neurologic Deficit and Recovery Rates in the Treatment of Complex Pediatric Spine Deformities Exceeding 100 Degrees or Treated by Vertebral Column Resection (VCR)

Authors

• Oheneba Boachie-Adjei, FOCOS Orthopaedic Hospital
• Henry Ofori Duah, Marquette UniversityFollow
• Kwadwo P. Yankey, FOCOS Orthopaedic Hospital
• Lawrence G. Lenke, The Allen Hospital
• Paul Sponseller, The Johns Hopkins Hospital
• Daniel J. Sucato, Scottish Rite Hospital for Children - Dallas
• Amer F. Samdani, Schriners Hospitals for Children - Philadelphia
• Peter Newton, Rady Children's Hospital
• Suken Shah, Nemours/Alfred I. du Pont Pediatrics
• Mark A. Erickson, Children's Hospital Colorado
• Harry Akoto, Korle-Bu Teaching Hospital
• Brenda Sides, Washington University School of Medicine
• Munish Gupta, Washington University School of Medicine
• Fox Pediatric Spinal Deformity Study

Document Type

Article

Publication Date

2021

Publisher

Elsevier

Source Publication

Spine Deformity

Source ISSN

2212-134x

Abstract

Study design

Prospective multicenter international observational study.

Objective

To investigate incidence of new neurologic deficit (NND) and the long-term recovery patterns following complex pediatric spine deformity surgery.

Summary of background data

The SRS M&M reports identify pediatric patients as having higher rate of new neurologic deficit compared with adults, while congenital and neuromuscular deformities are associated with higher new neurologic risks. Very few studies have had the large numbers of pediatric patients with curves exceeding 100 deg to ascertain the new neurologic deficit (NND) rates and recovery patterns as it relates to curve laterality and diagnosis.

Method

The FOX pediatric database from 17 international sites was queried for New Neurologic Deficit (NND) as characterized by change in American Spinal Injury Association (ASIA) Lower or Upper Extremity Motor Score. Recovery rates at specific intervals were recorded and related to the curve type and etiology.

Results

Data of 286 consecutive patients with normal pre-operative neurologic exams were reviewed. There were 160 females vs 125 males with an average age of 14.6 years. NND occurred in 27 patients (9.4%) in the immediate post-operative period. Diagnostic categories included idiopathic scoliosis (3 patients); idiopathic kyphoscoliosis(5 patients); congenital scoliosis (7 patients); congenital kyphoscoliosis (4 patients); congenital kyphosis (6 patients), other kyphosis (1 patient) and syndromic (1 patient). 1 patient was lost to follow-up (f/u) after discharge; 1 had chronic deficits at the first post-operative erect visit (from discharge to 9 months f/u) and was subsequently lost to follow-up; 2 patients were improving at 1-year f/u but lost to subsequent f/u. 16 patients had normal neurologic function by the time of the first post-operative erect visit, 21 patients at 1-year f/u and 21 patients at the 2-year f/u. 2 patients (0.69%) had improved NND at 2-year mark.

Conclusion

A significant proportion of patients with complex spine deformity experience NND. However, significant improvement in neurologic function can be expected over time as seen in this study without additional surgical intervention in most cases. Congenital deformities accounted for 63% of the patients experiencing NND.

Comments

Accepted version. Spine Deformity, Vol. 9 (2021): 427-433. DOI. © 2021 Scoliosis Research Society. Used with permission.

Henry Duah was affiliated with FOCOS at the time of publication.

Recommended Citation

Boachie-Adjei, Oheneba; Duah, Henry Ofori; Yankey, Kwadwo P.; Lenke, Lawrence G.; Sponseller, Paul; Sucato, Daniel J.; Samdani, Amer F.; Newton, Peter; Shah, Suken; Erickson, Mark A.; Akoto, Harry; Sides, Brenda; Gupta, Munish; and Fox Pediatric Spinal Deformity Study, "New Neurologic Deficit and Recovery Rates in the Treatment of Complex Pediatric Spine Deformities Exceeding 100 Degrees or Treated by Vertebral Column Resection (VCR)" (2021). College of Nursing Faculty Research and Publications. 1170.
https://epublications.marquette.edu/nursing_fac/1170