Evolución de las complicaciones neurológicas en la cirugía de deformidades vertebrales en la infancia

• Autores: Miguel A. Godoy, Carlos Tello, Alejandra Francheri Wilson, Mariano Noel, Eduardo Galaretto, Rodrigo Remondino, Ernesto Bersusky
• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 80, Nº. 1, 2015, págs. 43-52
• Idioma: español
• DOI: 10.15417/412
• Títulos paralelos:
  • Evolution of neurological complications in spinal deformity surgery in children
• Enlaces
  • Texto completo (pdf)
• Resumen
  • español

    Introducción: Se llevó a cabo un estudio retrospectivo descriptivo con el propósito de evaluar cómo evolucionaron los pacientes que sufrieron trastornos neurológicos a causa de una cirugía de las cifoescoliosis en la infancia.Materiales y Métodos: Se evaluó a 9 pacientes sin alteraciones neurológicas previas, que presentaron complicaciones neurológicas luego de un procedimiento quirúrgico por escoliosis o cifosis, operados en nuestra institución, durante un período de 10 años. Resultados: las etiologías de las deformidades fueron: 4 escoliosis idiopáticas, 2 escoliosis congénitas, una secundaria a neurofibromatosis de tipo 1, una cifosis idiopática y una poslaminectomía por miofibrosarcomatosis. Cinco pacientes tuvieron episodios neurofisiológicos intraquirúrgicos. Todos requirieron, al menos, una segunda intervención quirúrgica para solucionar su patología de base. La lesión neurológica fue: lesión radicular (un caso) y lesión del cordón medular (8 casos); 6 sufrieron una lesión medular completa (75%) que se manifestó como una paresia bilateral y 2 (25%), una lesión medular incompleta con monoparesia, sólo 2 quedaron con vejiga neurogénica.Conclusión: la detección temprana de una complicación neurológica, su diagnóstico etiológico y la resolución quirúrgica mejoran la evolución neurológica del paciente, y evitan la secuela o disminuyen su gravedad. 

  • English

    Background: A retrospective descriptive study was performed to assess the outcome of neurological complications due to kyphosis or scoliosis surgery in children.Methods: Nine patients who suffered neurological complication during kyphosis and/or scoliosis deformity surgery operated on our institution from May 2003 to June 2013 were evaluated.Results: Etiologies observed were: 4 idiopathic scolioses, 2 congenital scolioses, one associated with neurofibromatosis type 1, one idiopathic kyphosis and one myofibrosarcomatosis post-laminectomy surgery. Five patients presented intraoperative neurological changes. All patients needed at least a second surgical intervention to solve the spine deformity. The topographic classification of the neurological injury was: radicular injury (one patient); spinal cord injury (8 patients), 6 presented complete spinal injury (75%) which manifested with bilateral paresis and 2 patients (25%) suffered an incomplete spinal injury with monoparesis, only 2 stayed with neurogenic bladder.Conclusion: Early detection of a neurological complication, its etiological diagnosis and surgical resolution improve neurological outcome, avoiding or reducing its sequel.  

• Referencias bibliográficas
  • MacEwen GD, Bunnell WP, Siriam K. Acute neurological complications in the treatment of scoliosis. A report of the Scoliosis
  • Research Society. J Bone Joint Surg Am 1975;57:404-8.
  • Diab M, Smith AR. Neural complications in the surgical treatment of adolescent idiopathic scoliosis. Spine 2007;32(24):2759-
  • Winter RB. Neurologic safety in spinal deformity surgery. Spine 1997;22:1527-33.
  • Asher M, Lai SM, Burton D, Manna B, Cooper A. Safety and efficacy of Isola instrumentation and arthrodesis for adolescent
  • idiopathic scoliosis: two- to 12-year follow up. Spine 2004;15:2013-23.
  • Stagnara P. Experience with the wake-up test in 623 cases (1970-1977). Paper presented at: Italian Society for Spinal Deformity,
  • , Rome, Italy.
  • Fujita M, Diab M, Xu Z, Puttlitz C. A biomechanical analysis of sublaminar and subtransverse process fixation using metal
  • wires and polyethylene cables. Spine 2006;31:2202-8.
  • Wilber RG, Thompson GH, Shaffer JW, Brown RH, Nash CL Jr. Postoperative neurological deficit in segmental spinal instrumentation.
  • A study using spinal cord monitoring. J Bone Joint Surg Am 1984;8(66):1178-87.
  • Girardi FP, Boachie-Adjei O, Rawlins BA. Safety of sublaminar wires with Isola instrumentation for the treatment of idiopathic
  • scoliosis. Spine 2000;15:691-5.
  • Coe JD, Arlet V, Donaldson W, Berven S, Hanson D, Mudiyam R, Perra J, Shaffrey C. Complications in spinal fusion for
  • adolescent idiopathic scoliosis in the new millenium: a report of the Scoliosis Research Society Morbidity and Mortality Committee.
  • Spine 2006;31:345-9.
  • Cusick JF, Jyklebust J, Syvoloski M. Effects of vertebral column distraction in the monkey. J Neurosurg 1982;57:651-9.
  • Bridwell KH, Lenke LG, Baldus C, Blanke K. Major intraoperative neurologic deficits in pediatric and adult spinal deformity
  • patients: Incidence and etiology at one institution. Spine 1998;23:324-31.
  • Pahys J, Guille J. Neurologic injury in the surgical treatment of idiopathic scoliosis: guidelines for assessment and management.
  • J Am Acad Orthop Surg 2009;17:426-34.
  • Yamada T, Yeh M, Kimura J. Fundamental principles of somatosensory evoked potentials. Phys Med Rehabil Clin N Am
  • ;15:19-42.
  • Belmont P, Klemme W, Dhawan A, Polly D. In vivo accuracy of thoracic pedicle screws. Spine 2001;26:2340-6.
  • Grundy BL, Nash CL, Brown RH. Anterior pressure manipulation alters spinal cord function during correction of scoliosis.
  • Anesthesiology 1981;54:249-53.
  • Kling TF, Fergusson NV, Leach AB. The influence of induced hypotension and spine distraction on canine spinal cord blood
  • flow. Spine 1985;10:878-83.
  • Naslund TC, Hollier LH, Money SR, Facundus EC, Skenderis BS II. Protecting the ischemic spinal cord during aortic clamping:
  • The influence of anesthetics and hypothermia. Ann Surg 1992;215:409-
  • Vauzelle C, Stagnara P, Jouvinroux P. Functional monitoring of spinal cord activity during spinal surgery. Clin Orthop
  • ;93:173-8.
  • Nash CL Jr, Lorig RA, Schatzinger LA, Brown RH. Spinal monitoring during operative treatment of the spine. Clin Orthop
  • Relat Res 1977;126:100-5.
  • Padberg AM, Wilson-Holden TJ, Lenke LG, Bridwell KH. Somatosensory- and motor-evoked potential monitoring without a
  • wake up test during idiopathic scoliosis surgery: an accepted standard of care. Spine 1998;23:1392-1400.
  • Macdonald DB. Intraoperative motor evoked potential monitoring: Overview and update. J Clin Monit Comput 2006;20:347-77.
  • Lieberman J, Lyon R, Feiner J. The efficacy of motor evoked potenctials in fixed sagittal imbalance deformity correction surgery.
  • Spine 2008;13: E414-E424.
  • Lotto M, Banoub M, Schubert A. Effects of anesthetic agents and physiologic changes on intraoperative motor evoked potentials.
  • J Neurosurg Anesthesiol 2004;16:32-42.
  • DiCindio S, Schwartz DM. Anesthetic management for pediatric spinal fusion: Implications of advances in spinal cord monitoring.
  • Anesthesiol Clin North Am 2005;23:765-87.
  • Mooney JF III, Bernstein R, Hennrikus WL Jr, MacEwen GD. Neurologic risk management in scoliosis surgery. J Pediatr
  • Orthop 2002;22:683-9.
  • Devlin VJ, Schwartz DM. Intraoperative neurophysiologic monitoring during spinal surgery. J Am Acad Orthop Surg
  • ;15:549-60.
  • Raynor BL, Lenke LG, Kim Y. Can triggered electromyograph thresholds predict safe thoracic pedicle screw placement? Spine
  • ;27:2030-5.
  • Tsai RY, Yang RS, Nuwer MR. Intraoperative dermatomal evoked potencial monitoring fails to predict outcome from lumbar
  • decompression surgery. Spine 1997;22:1970-5.
  • Bracken MB, Shepard MJ, Holford TR. Administration of methylprednisolone for 24 or 48 hours or tirilazadmesylate for 48
  • hours in the treatment of acute spinal cord injury: Result of the Third National Acute Spinal Cord Injury Randomized Controlled
  • Trial. National Acute Spinal Cord Injury Study. JAMA 1997;277:1597-1604.
  • Przybylski GJ, Resnick DK, Ryken TC. Pharmacological therapy after acute spinal cord injury. Neurosurgery 2002;50(3
  • Suppl):S63-70.
  • Sidhu GS, Ghag A, Prokuski V, Vaccaro AR, Radcliff KE. Civilian gunshot injuries of the spinal cord: a systematic review of
  • the current literature. Clin Orthop Relat Res 2013;471:3945-55.
  • Potenza V, Weinstein Sl, Neyt JG. Dysfunction of the spinal cord during spinal arthrodesis for scoliosis: Recommendations for
  • early detection and treatment. A case report. J Bone Joint Surg Am 1998;80:1679-83.
  • Carlson GD, Minato Y, Okada A. Early time-dependent decompression for spinal cord injury: vascular mechanisms of recovery.
  • J Neurotrauma 1997;14:951-62.
  • Yeoman PM, Gibson MJ, Hutchinson A. Influence of induced hypotension and spinal distraction on feline spinal somatosensory
  • evoked potentials. Br J Anesth 1989;63:315-20.
  • Scivoletto G, Tamburella F, Laurenza L, Torre M, Molinari M. Who is going to walk? A review of the factors influencing
  • walking recovery after spinal cord injury. Front Hum Neurosci 2014;8:141.
  • Burns A, Marino R, Flanders A, Flett H. Clinical diagnosis and prognosis following spinal cord injury. Handb Clin Neurol
  • ;109:47-62.
  • Hillen BK, Abbas JJ, Jung R. Accelerating locomotor recovery after incomplete spinal injury. Ann NY Acad Sci 2013;1279:164-