Tsirikos A I, Howitt S P, McMaster M J
Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, UK.
J Bone Joint Surg Br. 2008 Apr;90(4):474-9. doi: 10.1302/0301-620X.90B4.20011.
Segmental vessel ligation during anterior spinal surgery has been associated with paraplegia. However, the incidence and risk factors for this devastating complication are debated. We reviewed 346 consecutive paediatric and adolescent patients ranging in age from three to 18 years who underwent surgery for anterior spinal deformity through a thoracic or thoracoabdominal approach, during which 2651 segmental vessels were ligated. There were 173 patients with idiopathic scoliosis, 80 with congenital scoliosis or kyphosis, 43 with neuromuscular and 31 with syndromic scoliosis, 12 with a scoliosis associated with intraspinal abnormalities, and seven with a kyphosis. There was only one neurological complication, which occurred in a patient with a 127 degrees congenital thoracic scoliosis due to a unilateral unsegmented bar with contralateral hemivertebrae at the same level associated with a thoracic diastematomyelia and tethered cord. This patient was operated upon early in the series, when intra-operative spinal cord monitoring was not available. Intra-operative spinal cord monitoring with the use of somatosensory evoked potentials alone or with motor evoked potentials was performed in 331 patients. This showed no evidence of signal change after ligation of the segmental vessels. In our experience, unilateral segmental vessel ligation carries no risk of neurological damage to the spinal cord unless performed in patients with complex congenital spinal deformities occurring primarily in the thoracic spine and associated with intraspinal anomalies at the same level, where the vascular supply to the cord may be abnormal.
前路脊柱手术中的节段性血管结扎与截瘫有关。然而，这种严重并发症的发生率和危险因素仍存在争议。我们回顾了346例年龄在3至18岁之间的连续儿科和青少年患者，他们通过胸段或胸腹联合入路接受了前路脊柱畸形手术，在此过程中结扎了2651条节段性血管。其中特发性脊柱侧凸患者173例，先天性脊柱侧凸或后凸患者80例，神经肌肉性脊柱侧凸患者43例，综合征性脊柱侧凸患者31例，与椎管内异常相关的脊柱侧凸患者12例，后凸患者7例。仅发生了1例神经并发症，该并发症发生在一名患有127度先天性胸段脊柱侧凸的患者身上，该患者存在单侧未分节骨桥并伴有同一水平的对侧半椎体，同时合并胸段脊髓纵裂和脊髓栓系。该患者在本系列研究早期接受手术，当时术中脊髓监测尚未可用。331例患者术中使用体感诱发电位单独或联合运动诱发电位进行脊髓监测。结果显示节段性血管结扎后无信号变化的证据。根据我们的经验，单侧节段性血管结扎不会对脊髓造成神经损伤风险，除非在主要发生于胸段脊柱且与同一水平椎管内异常相关的复杂先天性脊柱畸形患者中进行，此类患者脊髓的血供可能异常。
