Delayed quadriparesis after posterior spinal fusion for scoliosis: a case series
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CASE SERIES
Delayed quadriparesis after posterior spinal fusion for scoliosis: a case series Milad Alam1 · Harry L. Shufflebarger1 · Augustus John Rush3 · Samuel Rosas2 · William F. Lavelle3 · Paul D. Sponseller4 · Jahangir Asghar5 Received: 24 February 2020 / Accepted: 29 March 2020 © Scoliosis Research Society 2020
Abstract Study design A multicenter retrospective IRB exempt case series analyzing clinical and radiographical data of patients treated by three surgeons over the past two decades was conducted. Objective To examine the factors involved in the development of quadriparesis in patients who underwent posterior spinal fusion for scoliosis. Summary of background data Delayed spinal cord infarcts usually present at the region of instrumentation according to reports from the Scoliosis Research Society. Nonetheless, there is a lack of data regarding factors associated with delayed quadriparesis following posterior spinal fusion Methods Evaluated variables were age, Cobb angle, blood loss, and curve correction percentage. Postoperative imaging was also evaluated to determine factors indicative of the etiology of the quadriparesis. Results Eight patients presented delayed postoperative quadriparesis. All patients had a postoperative examination equal to that of baseline. The first patient deteriorated at 6 h postoperatively and the most delayed patient presented 4 days postoperatively. Six patients had neuromuscular disorders and 2 had adolescent idiopathic scoliosis. Mean age was 13.7, mean curve magnitude was 78.7°, mean percent curve correction was 71% and the mean estimated blood loss was 1185 cc. Seven of eight patients had documented peri- or postoperative hypotension. Conclusions Cervical infarction is the likely cause of delayed quadriparesis after posterior spinal fusion. Even though the underlying etiology continues to be unclear, postoperative hypotension, curve magnitude, percent curve correction, and the presence of cervical kyphosis/stenosis may be contributory and need to be closely evaluated. Level of evidence IV, Case Series Keywords Quadriparesis · Tetraplegia · Spinal cord diseases · Scoliosis · Neuromuscular disease
* William F. Lavelle [email protected]
1
Department of Orthopedics and Rehabilitation, University of Miami, 1400 NW 12thAve., Miami, FL 33136, USA
Milad Alam [email protected]
2
Department of Orthopedic Surgery, Wake Forest Baptist Health, 1 Medical Blvd., Winston‑Salem, NC 27157, USA
Harry L. Shufflebarger [email protected]
3
Department of Orthopedic Surgery, SUNY Upstate Medical University, 720 E. Adams St., Syracuse, NY 13210, USA
Augustus John Rush [email protected]
4
Department of Orthopedic Surgery, Johns Hopkins School of Medicine, 610 N. Caroline St. #5212, Baltimore, MD 21287, USA
5
Nicklaus Children’s Hospital, 3100 SW 62nd Ave., Miami, FL 33165, USA
Samuel Rosas [email protected] Paul D. Sponseller [email protected] Jahangir Asghar [email protected]
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Introduction Neurologic injuries are one o
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