#2245

Category

Miscellaneous (Spondy, Trauma, Tumor, etc.)

Author(s)

Altug Yucekul MD, Gulden Demirci Otluoglu MD, Mohamed Dalla , Firat Gulagaci , Nuray Sogunmez MS, Caglar Yilgor MD, M. Memet Ozek MD, Ahmet Alanay MD

Title

Safety and Efficacy of Concurrent Spinal Deformity and Intra-Dural Surgery: Case Series

Summary

6 out of 19 patients (32%) with coexisting spinal deformities and intra-spinal pathologies experienced complications that resolved without sequela within 1-6 months after single-stage concurrent Orthopedic and Neurosurgical interventions.

With the proper use of intraoperative neuromonitoring (IONM), concurrent surgery for early-onset scoliosis patients with intradural pathology may be safe and efficient without significant long-term sequela.

Hypothesis

Concurrent surgery is safe and effective in pediatric deformity patients having intra-dural pathologies.

Design

Retrospective case series

Introduction

Traditionally, coexisting spinal and intra-dural pathologies were treated with staged neurosurgical and orthopedic interventions. Today, the recent advances in IONM have allowed for concurrent surgeries. Potential advantages of concurrent surgery are: increased surgeon comfort via a single exposure, and increased patient comfort via single anaesthesia and hospitalization as well as decreased cost.

Methods

Chart review included patient’s age, sex, clinical presentation, associated anomalies, radiological measurements, operative details, complications and surgical outcome. Neurosurgical team addressed intradural pathology first, by release of tethered cord(13), bone spur excision(4), hemi-lipomyelomeningocele repair with duraplasty(2). Orthopedic team then performed posterior fusion(11), hemivertebrectomy(4), vertebral column resection(1) or Magnetically-controlled growing rod application(3) depending on the patient's pathology.

Results

19 pts (13F, 6M, 11.7±5.1 years) with a mean f-up of 23 (12-39) months were included. 8 (42%) pts had pre-op neurological deficits. A mean of 7.4 levels (2-16) were fused. Mean surgical time was 426 (240-700) minutes. Mean EBL was 654 (200- 1300) ml. Mean day to discharge was 5.8 (3-8) days. Pre and postop mean coronal Cobb angles were 56.2° (34°-137°) and 25.5° (7°-56°), respectively. One patient had motor radiculopathy after spondylolisthesis reduction that was revised the same day and reduction percentage was decreased. 3 pts (15.7%) had IONM loss that returned back to baseline during surgery. 2 of them had motor radiculopathy that were resolved within 6 months. 2 pts (10.5%) had CSF leakage. One of them had a superficial wound infection and had a debridement. One patient had a superior mesenteric artery syndrome. A total of 6 pts (32%) experienced complications that are resolved without sequela within 1-6 months.

Conclusion

Patients with symptomatic intradural pathology concomitant with spinal deformity are candidates to be treated with concurrent neurosurgical and orthopedic interventions.

Take Home Message

Single-stage concurrent orthopedic and neurosurgery for pediatric deformity patients with intra-spinal pathology may be safe and efficient without significant long-term sequela.

Presentation Type Clinical Study - Therapeutic Session Type

Podium or E-Poster

Level of Evidence

Level III

Funding Was this study funded by an SRS Research Grant?

No

Authorship

Single-Center

What is the enrollment time period of the study?

2013-2016

How many patients were eligible for inclusion from all study sites during this time frame?

19

How many patients were enrolled from all study sites?

19

Were the patients enrolled consecutively?

Yes

What was the minimum time period of follow-up?

2 year

How many patients reached the minimum follow-up time?

12