Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, USA.
Spine Deform. 2021 Mar;9(2):395-401. doi: 10.1007/s43390-020-00241-y. Epub 2020 Nov 17.
We sought to determine whether the axial spinal cord classification by Sielatycki et al. would be associated with increased intraoperative neuromonitoring (IONM) alerts for pediatric scoliosis patients undergoing posterior spinal fusion (PSF) surgery.
Children less than age 19 with scoliosis undergoing PSF were retrospectively reviewed. Axial-T2 MRI of the thoracic apex was reviewed for spinal cord/CSF architecture as described by Sielatycki et al.: Type 1-circular cord with visible CSF, Type 2-circular cord but no visible CSF at apical concavity, and Type 3-cord deformed with no intervening CSF. Intraoperative neuromonitoring reports, operative records and preoperative radiographs were reviewed.
90 patients met the inclusion criteria. Rate of neurologic events was Type 1: 2% (1/41 patients), Type 2: 14.3% (4/28), Type 3: 57.1% (12/21) (Type 1 vs 2 p = 0.06; Type 1 vs 3 p < 0.0001; Type 2 vs 3 p = 0.0017). Three patients with a Type 3 cord awoke with significant deficits. In comparison to Type 1 cords, Type 3 and Type 2 spinal cords were associated with increased coronal and total deformity angular ratios (Type 1 vs 3 p = 0.035 and 0.0054 respectively; Type 1 vs 2 p = 0.042 and 0.03 respectively). There was no difference in gender, diagnosis category, age at surgery, Cobb angle or kyphosis between the three groups.
The axial spinal cord classification correlated with IONM alerts and greater severity of spinal deformity in pediatric scoliosis patients.
IV, retrospective cohort study.
我们旨在确定 Sielatycki 等人提出的轴向脊髓分类是否与接受后路脊柱融合术（PSF）的小儿脊柱侧凸患者的术中神经监测（IONM）警报增加相关。
回顾性分析了年龄小于 19 岁的接受 PSF 的脊柱侧凸患儿。根据 Sielatycki 等人的描述，对胸椎顶的轴向-T2 MRI 进行了脊髓/CSF 结构的评估：1 型-圆形脊髓，可见 CSF；2 型-圆形脊髓，但在顶凹处不可见 CSF；3 型-脊髓变形，其间无 CSF。回顾了术中神经监测报告、手术记录和术前 X 线片。
90 例患者符合纳入标准。神经事件发生率为 1 型：2%（41 例中的 1 例），2 型：14.3%（28 例中的 4 例），3 型：57.1%（21 例中的 12 例）（1 型与 2 型相比，p=0.06；1 型与 3 型相比，p<0.0001；2 型与 3 型相比，p=0.0017）。3 例 3 型脊髓患儿苏醒时存在明显的缺陷。与 1 型脊髓相比，3 型和 2 型脊髓与冠状面和总畸形角度比的增加相关（1 型与 3 型相比，p=0.035 和 0.0054；1 型与 2 型相比，p=0.042 和 0.03）。三组间性别、诊断类别、手术年龄、Cobb 角或后凸无差异。
轴向脊髓分类与 IONM 警报以及小儿脊柱侧凸患者脊柱畸形的严重程度相关。
IV，回顾性队列研究。
