Risk Factors, Assessments, and Treatment of Intra- and Postoperative New Neurologic Deficits in Complex Spine Disorders

Abstract

\n Background: New Neurologic Deficits (NND) is one of the most threatening complications of spinal surgery, and its incidence in complex spine disorders ranges from 0.99% to 3.54%, which is higher than that in noncomplex spine disorders. To date, the early management of NNDs in complex spine disorders remains poorly researched.Methods. A retrospective review was performed for patients with complex spine disorders who experienced NNDs from 2010 to 2020. The pre- and postoperative neurologic condition was assessed using the American Spinal Injury Association (ASIA) scale. Patient age, sex, diagnosis, lesion level, operating time, blood loss, intraoperative neurophysiologic monitoring (IONM) test results, wake-up test results, lowest mean arterial pressure (MAP) at surgery, NND types, possible etiology of NNDs, treatment, and total recovery time were reviewed retrospectively.Results: Five patients with complex spine disorders who experienced NNDs were included (4 males and 1 female; average age of 23±17 years) in the present study. The primary diseases varied from congenital scoliosis to Langerhans histiocytosis. The mean operation time was 488±264 min with a mean blood loss of 1920±1413 mL, and the mean lowest MAP at surgery was 66.2±7.6 mmHg. Regarding the type of NND, 4 cases had spinal cord injuries, and 1 case had nerve root injury. The possible etiologies of NNDs in the patients were as follows: spinal cord overtraction and spinal cord ischemia in 2 cases; spinal cord compression and spinal cord ischemia in 2 cases; and spinal cord ischemia 1 case. Two patients underwent revision surgery, and 1 patient underwent prolonged surgery. The average hospital stay was 37±11 days. The preoperative ASIA score was 4.4±0.8, while the postoperative ASIA score was 0.8±0.7. All patients achieved full recovery at a mean follow-up period of 6.8±4.5 months.Conclusion: Surgeries for complex spine disorders carry significant risks that can lead to intraoperative or postoperative NNDs. NNDs can occur secondary to spinal cord overtraction (overcorrection of deformity), spinal cord compression (due to implants, bone tissue, soft tissue, or hematoma), and spinal cord ischemia (owing to anemia, low MAP, vascular embolism, or intramedullary vascular malformation). Patients with risk factors should be closely observed during and after the operation. Once NNDs are confirmed, emergency examination should be performed to rule out spinal cord overtraction and spinal cord compression. If a mechanical obstruction is found, emergency revision surgery is recommended. If no mass lesion is identified, conservative treatment should be utilized for the principle of maintaining arterial pressure, nutriating nerves, dilating blood vessels, and eliminating edema.