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The risk of delayed spinal cord injury in pediatric spinal deformity surgery

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Abstract

Delayed spinal cord injury (SCI) hours or days after surgery, with uneventful monitoring and initial normal postoperative neurological examination, is a rare complication. Based on anecdotal evidence, the risk of delayed spinal cord injury might be higher than previously assumed. Therefore the aim of this study was to determine the risk of delayed SCI after pediatric spinal deformity surgery between 2013-2019 in the Netherlands. The total number of pediatric spinal deformity surgeries performed for scoliosis or kyphosis between 2013–2019 was obtained from the Dutch National Registration of Hospital Care. All eleven Dutch hospitals that perform pediatric spinal deformity surgery were contacted for occurrence of delayed SCI. From the identified patients with delayed SCI, the following data were collected: patient characteristics, details about the SCI, the surgical procedure, management and degree of improvement.

2884 pediatric deformity surgeries were identified between 2013–2019. Seven patients (0.24%) with delayed SCI were reported: 3 idiopathic, 2 neuromuscular (including 1 kypho-scoliosis) and 2 syndromic scoliosis. The risk of delayed SCI after pediatric deformity surgery was 1:595 in idiopathic scoliosis, 1:214 in syndromic scoliosis, 1:201 in neuromuscular scoliosis. All seven patients had a documented normal neurological examination in the first postoperative period; neurological deficits were first diagnosed at a median 16h (range 2.5-40) after surgery. The risk of delayed SCI after pediatric deformity surgery is higher than previously reported, especially in patients with non-idiopathic scoliosis. Regular postoperative testing for late neurologic deficit should be performed for timely diagnosis and management of this devastating complication.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Orthopedics and Sports Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands

    J. P. H. J. Rutges & J. J. M. Renkens

  2. Department of Orthopedics, Onze Lieve Vrouwe Gasthuis OLVG, Amsterdam, The Netherlands

    D. H. R. Kempen

  3. Department of Orthopedics, UMC Groningen, Groningen, The Netherlands

    C. Faber

  4. Department of Orthopedics, Amsterdam UMC, Amsterdam, The Netherlands

    A. Stadhouder

  5. Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands

    M. C. Kruyt, R. M. Castelein & T. P. C. Schlösser

  6. Department of Orthopedics, Isala Zwolle, Zwolle, The Netherlands

    A. Mostert

  7. Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands

    P. P. Horsting & L. W. L. de Klerk

  8. Department of Orthopedics, Radboud UMC, Nijmegen, The Netherlands

    M. de Kleuver

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  1. J. P. H. J. Rutges
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  3. D. H. R. Kempen
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  11. R. M. Castelein
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  12. T. P. C. Schlösser
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Contributions

JPHJR, JJMR, DHRK, CF, AS, MCK, AM, PPH, LWLK, MK, RMC, TPCS: (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to J. P. H. J. Rutges.

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Conflict of interest

No conflict of interest for any of the authors.

Ethical approval

This study was approved by the Medical ethical committee of the Erasmus MC: MEC-2022–0427.

Informed consent

Informed consent was obtained from all included patients with delayed SCI.

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Rutges, J.P.H.J., Renkens, J.J.M., Kempen, D.H.R. et al. The risk of delayed spinal cord injury in pediatric spinal deformity surgery. Spine Deform 11, 617–625 (2023). https://doi.org/10.1007/s43390-022-00626-1

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  • DOI: https://doi.org/10.1007/s43390-022-00626-1

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