FOCOS Orthopaedic Hospital, Accra, Ghana.
New York Presbyterian, The Allen Hospital, New York, USA.
Spine Deform. 2021 Mar;9(2):427-433. doi: 10.1007/s43390-020-00211-4. Epub 2020 Oct 9.
Prospective multicenter international observational study.
To investigate incidence of new neurologic deficit (NND) and the long-term recovery patterns following complex pediatric spine deformity surgery. 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.
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.
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.
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.
前瞻性多中心国际观察性研究。
研究复杂儿科脊柱畸形手术后新发神经功能缺损（NND）的发生率及长期恢复模式。SRS M&M 报告指出，与成人相比，儿科患者新发神经功能缺损的发生率更高，而先天性和神经肌肉性畸形与更高的新发神经风险相关。很少有研究有大量的儿科患者，其曲线超过 100 度，以确定与曲线侧别和诊断相关的新发神经缺损（NND）发生率和恢复模式。
从 17 个国际站点的 FOX 儿科数据库中查询新的神经功能缺损（NND），其特征为美国脊柱损伤协会（ASIA）下肢或上肢运动评分的变化。记录特定时间间隔的恢复率，并与曲线类型和病因相关。
回顾了 286 例术前神经检查正常的连续患者的数据。女性 160 例，男性 125 例，平均年龄 14.6 岁。术后即刻发生新发神经缺损（NND）27 例（9.4%）。诊断类别包括特发性脊柱侧凸（3 例）；特发性后凸侧凸（5 例）；先天性脊柱侧凸（7 例）；先天性后凸侧凸（4 例）；先天性后凸（6 例），其他后凸（1 例）和综合征（1 例）。1 例患者在出院后失访；1 例患者在术后第一次直立就诊时存在慢性缺损（从出院到 9 个月随访），随后失访；2 例患者在 1 年随访时改善，但随后失访。16 例患者在术后第一次直立就诊时神经功能正常，21 例患者在 1 年随访时神经功能正常，21 例患者在 2 年随访时神经功能正常。2 例（0.69%）患者在 2 年时 NND 改善。
相当一部分复杂脊柱畸形患者会出现 NND。然而，正如本研究所示，在大多数情况下无需额外的手术干预，随着时间的推移，神经功能可以得到显著改善。先天性畸形占新发神经功能缺损患者的 63%。
