Samtani Rahul G, Bernatz James T, Halanski Matthew A, Noonan Kenneth J
Orthopaedics, University of Wisconsin Hospital and Clinics, Madison, USA.
Orthopaedics, University of Wisconsin, Madison School of Medicine and Public Health, Madison, USA.
Cureus. 2019 Oct 5;11(10):e5840. doi: 10.7759/cureus.5840.
Spinal fusion for adolescent idiopathic scoliosis (AIS) can have many potential complications, including spinal cord injury. Most often, spinal cord injury occurs in the region of surgery due to direct mechanical trauma. Vascular compromise in this area may also occur due to a high degree of correction or excessive distraction of the spine. In these cases, the impairment of spinal cord function is often detected intraoperatively with spinal cord monitoring and confirmed in the immediate postoperative period. Injury to the spinal cord above the level of instrumentation is rare. We review the clinical history and outcome of a female adolescent who underwent posterior spinal fusion (PSF) for AIS and developed a cervical spine injury 12 hours postoperatively. The patient is a 13-year old female who underwent PSF for AIS from T1 to L1 for progressive scoliosis measuring over 53 degrees in her right thoracic curve. During surgery, she had modest correction with minimal blood loss and with normal intraoperative motor evoked and somatosensory evoked potentials. The immediate postoperative examination was neurologically intact. Twelve hours later, she developed weakness and tingling in her right upper extremity. Magnetic resonance imaging (MRI) of the cervical spine demonstrated myelomalacia on the right side of the spinal cord at the C5-7 levels. Cervical spine injuries are rare following lower-level fusions, however, these injuries can occur and it is important to be vigilant in monitoring patients for these symptoms. The exact mechanism is unknown and may include a combination of postoperative hypotension with altered vascular anatomy from cord stretch and abnormal cervical positioning.
青少年特发性脊柱侧凸（AIS）的脊柱融合术可能会有许多潜在并发症，包括脊髓损伤。脊髓损伤最常发生在手术区域，原因是直接的机械创伤。该区域的血管受压也可能由于脊柱的高度矫正或过度牵张而发生。在这些情况下，脊髓功能损害通常在术中通过脊髓监测检测到，并在术后即刻得到证实。器械置入水平以上的脊髓损伤很少见。我们回顾了一名接受后路脊柱融合术（PSF）治疗AIS的女性青少年的临床病史及结果，该患者术后12小时出现颈椎损伤。患者为一名13岁女性，因AIS行T1至L1的PSF，以治疗其右胸弯超过53度的进行性脊柱侧凸。手术过程中，她得到了适度矫正，失血极少，术中运动诱发电位和体感诱发电位均正常。术后即刻检查神经功能完好。12小时后，她出现右上肢无力和刺痛。颈椎磁共振成像（MRI）显示C5 - 7水平脊髓右侧有脊髓软化。低位融合术后颈椎损伤很少见，然而，这些损伤是可能发生的，因此对患者这些症状进行监测时保持警惕很重要。确切机制尚不清楚，可能包括术后低血压与脊髓拉伸导致的血管解剖结构改变以及异常颈椎位置的综合作用。
