| Objective: To analyze neurological complications of posterior vertebral column resection in the treatment of severe rigid congenital spinal deformities, and to study application value and influential factors of somatosensory evoked potentials monitoring during surgery.Methods: There were 88 patients with severe rigid congenital spinal deformities who underwent PVCR in our hospital from June 2007 to November 2012.There were 39 males and 49 females at the average age of 17±7 years old(range 6-46years). The diagnosis include congenital scoliosis in 18 cases, Kyphoscoliosis in 63 cases, kyphosis in 7 cases, of them,27 cases accompanied spinal cord deformities, 15 cases with preoperative neurologic compromise, 25 cases with pulmonary function abnormalities. To measure the Cobb angle and balance at preoperative, postoperative and follow up, and to record the operation report,intraoperative neurophysiological monitoring, neurological complications and at follow up. To analyze incidence of complications and risk factors of neurological complications, and to analyze the correlation between decline rate of SSEPs wave amplitude and operative factors.Results: The average follow up was 47 months( range 24 to 88 months), The number of resected vertebrae average 1.3( range 1 to 3), operative time average 502.4±170.3min(range 165.0 to 880.0 min), estimate blood loss average 2238±2214 ml(range 100 to 11 500 ml)for an average 69.3% blood volume loss(range 9% to 299%). The average preoperative major coronal curve of 93.6°±25.1°corrected to 22.2°±13.1°,at the final follow-up, the coronal curve was 22.9°±13.2° with a correction of 76.8%. The average preoperative coronal imbalance(absolute value) was 2.5cm decreasing to 1.3cm at the final follow-up. The average preoperative major sagittal curve of 88.2°±25.6°corrected to 28.7°±16.9°,at the final follow-up, the sagittal curve was 29.2°±17.0°, average decrease in kyphosis of 59.0°±16.8°. The average preoperative sagittal imbalance(absolute value) was 3.1cm decreasing to 1.2cm at the final follow-up. Fourty-two patients(47.7%) developed a complications, of them, 40 patients(45.5%)developed a intraoperative complications, include blood volume loss greater than 50% in 37 cases(42.0%), pleural rupture in 1 case(1.1%), dura rupture in 1 case(1.1%), and intraoperative neurophysiological monitoring abnormal in 12 cases(13.6%);24 patients(27.3%)developed a postoperative complications, include upper respiratory infection in 2 cases(2.3%), pulmonary infection with pleural effuision in 1 case(1.1%),urinary system infection in 1 case(1.1%),delayed recovery in 7 cases(8.0%),atelectasis in 1 case(1.1%),cerebrospinal fluid leak in 1 case(1.1%),transient dyspnea in 1case(1.1%), neurological complications in 12 cases(13.6%). High rate of neurological complications was occurred in patients with operative time greater than 480 min, pulmonary dysfunction, blood volume loss greater than 50%, T7-T9 osteotomy and preoperative neurologic compromise(p=0.046, 0.000, 0.000, 0.033, 0.043). In all patients, 12 cases had abnormal SSEPs, SSEPs monitoring had sensitivity of 83.3%, specificity of 97.4%, false positive rate of 2.6% and false negative rate of 16.7%. There were linear correlations between decline rate of SSEPs wave amplitude and operation time, blood volume loss, number of vertebrae fixed(p=0.000, 0.000, 0.000), blood volume loss had most significant influence to SSEPs wave amplitude.Conclusion: PVCR can achieve satisfactory efficacy in treatment of severe rigid congenital spinal deformities, pulmonary dysfunction and blood volume loss greater than 50% was significant risk factors of neurological complications. SSEPs monitoring is an sensitive method to detect the function of spinal cord, but there are many influencing factors, and independent employment has own flaw. Therefore, We need to reasonable use a variety of monitoring methods during surgery. |
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