Özet Sistemi 2019
Özet Sistemi 2019
Miscellaneous (Spondy, Trauma, Tumor, etc.)
Altug Yucekul MD, Gulden Demirci Otluoglu MD, Mohamed Dalla , Firat Gulagaci , Nuray Sogunmez MS, Caglar Yilgor MD, M. Memet Ozek MD, Ahmet Alanay MD
Safety and Efﬁcacy of Concurrent Spinal Deformity and Intra-Dural Surgery: Case Series
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.
Concurrent surgery is safe and effective in pediatric deformity patients having intra-dural pathologies.
Retrospective case series
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.
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.
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.
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
Funding Was this study funded by an SRS Research Grant?
What is the enrollment time period of the study?
How many patients were eligible for inclusion from all study sites during this time frame?
How many patients were enrolled from all study sites?
Were the patients enrolled consecutively?
What was the minimum time period of follow-up?
How many patients reached the minimum follow-up time?