Spinal cord injury in high-risk complex adult spinal deformity surgery: review of incidence and outcomes from the Scoli-RISK-1 study

Abstract

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Study design</jats:title> <jats:p>Clinical case series.</jats:p> </jats:sec><jats:sec> <jats:title>Objective</jats:title> <jats:p>To describe the cause, treatment and outcome of 6 cases of perioperative spinal cord injury (SCI) in high-risk adult deformity surgery.</jats:p> </jats:sec><jats:sec> <jats:title>Setting</jats:title> <jats:p>Adult spinal deformity patients were enrolled in the multi-center Scoli-RISK-1 cohort study.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>A total of 272 patients who underwent complex adult deformity surgery were enrolled in the prospective, multi-center Scoli-RISK-1 cohort study. Clinical follow up data were available up to a maximum of 2 years after index surgery. Cases of perioperative SCI were identified and an extensive case review was performed.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Six individuals with SCI were identified from the Scoli-RISK-1 database (2.2%). Two cases occurred intraoperatively and four cases occurred postoperatively. The first case was an incomplete SCI due to a direct intraoperative insult and was treated postoperatively with Riluzole. The second SCI case was caused by a compression injury due to overcorrection of the deformity. Three cases of incomplete SCI occurred; one case of postoperative hematoma, one case of proximal junctional kyphosis (PJK) and one case of adjacent segment disc herniation. All cases of post-operative incomplete SCI were managed with revision decompression and resulted in excellent clinical recovery. One case of incomplete SCI resulted from infection and PJK. The patient’s treatment was complicated by a delay in revision and the patient suffered persistent neurological deficits up to six weeks following the onset of SCI.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Despite the low incidence in high-risk adult deformity surgeries, perioperative SCI can result in devastating consequences. Thus, appropriate postoperative care, follow up and timely management of SCI are essential.</jats:p> </jats:sec>