A critical event frequent lead to reversible spinal cord injury during vertebral column resection surgery

Shujie Wang; Fang He; Lanjun Guo; Chao Chen; Jianguo Zhang

doi:10.1007/s00586-024-08263-0

A critical event frequent lead to reversible spinal cord injury during vertebral column resection surgery

Eur Spine J. 2024 May 22. doi: 10.1007/s00586-024-08263-0. Online ahead of print.

Authors

Shujie Wang¹, Fang He², Lanjun Guo³, Chao Chen⁴, Jianguo Zhang⁵

Affiliations

¹ Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
² Department of Neuro-Electrophysiology Room, First Affiliated Hospital, University of Science and Technology of China, Hefei, 230036, People's Republic of China.
³ Neurophysiological Monitoring Service, University of California, San Francisco, CA, USA.
⁴ Department of Orthopaedics, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, People's Republic of China.
⁵ Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China. jgzhang_pumch@yahoo.com.

PMID: 38775820
DOI: 10.1007/s00586-024-08263-0

Abstract

Objective: To report a "critical phase" (between osteotomy completion and correction beginning) that will frequently lead to the reversible intraoperative neurophysiological monitoring (IOM) change during posterior vertebral column resection (PVCR) surgery.

Methods: The study sample consisted of 120 patients with severe spine deformity who underwent PVCR and deformity correction surgeries. Those patients were recruited consecutively from 2010 to 2018 January in our spine center. The detailed IOM data (the amplitude of MEP & SEP) and its corresponding surgical points were collected prospectively. Early and long-term postoperative neurologic outcomes were assessed for the following functions: motor, sensory, and pain at immediate postoperative and 1-year post-operation in this cases series.

Results: A total of 105 (105/120) patients presented varying degrees of IOM reduction in the critical phase; the mean IOM amplitude retention vs rescue rate was 27% ± 11.2 versus 58% ± 16.9, P < 0.01 (MEP) & 34% ± 8.3 versus 66% ± 12.4 P < 0.01 (SEP). Patients with postoperative spinal deficits often had a significantly longer IOM-alerting duration than the patients without (p < 0.01, Mann-Whitney U-test), and IOM-alerting duration greater than 39.5 min was identified as an independent predictor of the risk of postoperative spinal deficits.

Conclusions: The reversible IOM events probably often appear in the critical phase during PVCR surgery. The new postoperative spinal deficits are possible for patients without satisfied IOM recovery or alerting duration greater than 39.5 min. Timely and suitable surgical interventions are useful for rescuing the IOM alerts.

Keywords: Critical phase (osteotomy completion and correction beginning); IOM events; Intraoperative neuromonitoring (IOM); Posterior vertebral column resections (PVCR); Spinal deformity.